Billing • Regulated by Medicaid & Commercial Payers
Prior Authorization (Home Care)
Definition: Formal approval granted by a Medicaid managed care plan or insurer certifying that a requested home care service is medically necessary and approved for reimbursement.
Regulatory Impact & Compliance Overview
Prior authorizations specify the authorized procedure code, number of units (usually 15-minute increments), frequency, and start/end dates. EVV systems must track utilized units against authorizations to prevent unbillable over-servicing.
Governing Authority
Enforced by Medicaid & Commercial Payers in United States. Compliance with these standards is legally required for all licensed and participating care providers.
Automated Compliance
How AsanWork Enforces Prior Authorization (Home Care)
AsanWork builds compliance directly into daily scheduling workflows. Hard compliance stops prevent un-vetted, un-screened, or non-credentialed staff from receiving shift allocations, ensuring 100% audit readiness.
Related United States Healthcare Terms
Regulation
21st Century Cures Act
A landmark federal healthcare law passed in 2016 designed to accelerate medical innovation, prevent health data blocking, and mandate Electronic Visit Verification for Medicaid home care.
Payroll
Blended Regular Rate (Overtime)
The weighted average hourly rate used to calculate FLSA overtime when a caregiver works at two or more different pay rates in the same workweek.
Regulation
CMS Conditions of Participation (CoPs)
Federal health and safety requirements that home health agencies and healthcare organizations must meet to begin and continue participating in Medicare and Medicaid programs.
Payroll
California Daily Overtime
A California state labor law requiring overtime pay of 1.5x regular pay for hours worked beyond 8 in a single day, and double pay for hours past 12.