Built for Skilled Nursing & Long-Term Care
From admission to discharge, keep every day covered.
Skilled nursing facilities live and die by Medicare/Medicaid mix and benefit-day tracking. Coveragence makes coverage visibility automatic — across MA plans, dual-eligibles, Medicaid spend-down, and managed long-term services.
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THE SNF REALITY
The Medicare/Medicaid mix changes every day.
Long stays, complex eligibility, and benefit-day cliffs make a single missed update worth thousands per resident.
Medicare A benefit days
100-day cap tracking has to be flawless — and Medicare Advantage plans interpret the cap differently than traditional Medicare.
MA plan rule sprawl
Each Medicare Advantage plan has its own auth rules, LOC criteria, and post-acute pathways. Most aren't published clearly.
Medicaid spend-down
Resident liability, share-of-cost, and asset re-assessments shift coverage mid-stay — and re-determination cycles vary by state.
Dual-eligible coordination
D-SNP and Medicaid LTSS coordination requires constant cross-checking against two payers who don't talk to each other.
Hospital-to-SNF window
The 3-day inpatient stay rule (or its MA equivalent) determines whether the SNF gets paid at all — and the answer often arrives after admission.
Medicaid re-determinations
Annual eligibility re-determinations are the #1 cause of mid-stay revenue loss in long-term care.
HOW COVERAGENCE HELPS
Real-time coverage visibility for every resident, every day.
Coveragence keeps Medicare, Medicaid, MA, and dual-eligible coverage continuously verified — so revenue cycle teams stop reacting to denials and start preventing them.
Medicare & MA eligibility
Real-time eligibility across traditional Medicare, every MA plan, and Medicaid — including benefit-day balances and SNF qualification.
→ Eligibility Engine
Spend-down monitoring
Track resident liability and Medicaid share-of-cost continuously — and flag changes the moment they post.
→ Coverage Monitor
Dual-eligible coordination
Surface D-SNP and LTSS interactions in one place so your billing team always knows which payer is on the hook for which day.
→ Payer Database
Qualifying-stay verification
Confirm the 3-day inpatient rule (or MA waiver) before admission — and lock in coverage clarity from day one.
→ Rules Engine
The outcomes our SNF customers see.
$840
Average revenue protected per resident-day with full coverage visibility.
67%
Reduction in Medicaid re-determination losses.
5 days
Faster MA prior-auth turnaround.