Authorization
A payer-issued approval to deliver and bill for specific services within a defined period or unit limit. Authorizations must be in place before scheduling any Medicaid, VA, or insurance-funded services.
Also known as: authorization · auth · auth code · payer approval · coverage approval · benefit authorization
An authorization (often called an auth or auth code) is formal payer approval granted before services begin. It specifies what services are approved (e.g., personal care, homemaker), the unit or hour limit (e.g., 20 hours/week), the approved billing rate, and the benefit period (e.g., 90 days).
Authorizations can be time-based (expire on a specific date) or unit-based (expire when approved hours are consumed). Some authorizations auto-renew; others require proactive renewal before expiration.
Delivering services without a valid authorization — or exceeding the authorized scope — results in claim denial. Authorization management is a critical function in the intake and scheduling workflow.
In home care, this means…
Required during intake and assessment when establishing a new Medicaid, VA, or insurance client. Must be validated before scheduling a shift; used in billing to support every claim.
Related terms
Payer →
Any entity that pays for home care services: government programs (Medicaid, VA), managed care organizations, long-term care insurance companies, or private individuals and families (private pay). Payer mix is a critical driver of agency revenue and margin.
Medicaid Waiver →
A state-administered Medicaid program that covers home and community-based services (including personal care) as an alternative to nursing home placement. Eligibility requirements, covered services, and reimbursement rates vary significantly by state.
VA Benefits (Veterans Affairs) →
U.S. government home care benefits for eligible veterans, primarily through the Aid & Attendance program. VA is a meaningful payer for many home care agencies, though rates and program terms are subject to policy changes.
Claim →
An electronic billing document submitted to a government or insurance payer requesting reimbursement for services rendered. Claims include authorization codes, service codes, units delivered, dates of service, and provider information.
Intake →
The end-to-end onboarding process for a new client, from initial inquiry through completed assessment, signed service agreement, and first scheduled shift. Intake establishes the client record, payer eligibility, and care plan.
Assessment →
A structured in-home evaluation of a prospective client's functional, cognitive, and safety status used to build the care plan and determine appropriate service levels. Typically conducted by a care coordinator at the start of service.