01
Start with network and coverage status
An office manager needs to know whether coverage is active on the date of service and whether the treating provider participates in the plan's network. Our verification documents what the payer source makes available, including relevant effective dates, cost sharing and in network or out of network status. In network benefits are part of every verification. Your practice can choose whether out of network benefit details should also be included. There is no extra fee simply because a provider is out of network.
02
Identify visit limits by discipline
Therapy benefits sometimes include a limit on physical therapy visits, a shared rehabilitation visit count, or separate limits for occupational and speech therapy. Other plans calculate limits by calendar year, benefit year or rolling period. Under Full Benefits, we record the wording and remaining or used counts when available. We do not assume that a limit shown for one discipline applies to another. If the payer tool does not show a reliable number, the report clearly says that it could not be confirmed.
03
Research the CPT codes you send
Evaluation, therapeutic exercise, manual therapy, neuromuscular reeducation and other treatment services can have different benefit or authorization rules. Your staff sends the requested CPT or HCPCS codes as part of an approved Full Benefits request. We research the applicable online payer information where available and document the source and any restrictions. A code's appearance in a benefit tool never establishes medical necessity or guarantees reimbursement. Basic Eligibility does not include code-specific research.
04
Separate authorization from referrals
A plan may require a referral from the patient's primary care provider, prior authorization before selected visits, or additional review after an initial allowance. Full Benefits includes online research into those requirements for the submitted services. It does not automatically submit or obtain an authorization. Prior Authorization Assistance is separately scoped by custom quote. When the requirements depend on a location, provider type or treatment phase, the report identifies what still needs to be clarified.
05
Plan of care and documentation questions
Insurance verification is not a clinical plan of care review. A physical therapist remains responsible for evaluation, documentation, certification and any applicable physician or practitioner signature requirements. For office workflow, the important distinction is to capture payer coverage and authorization information alongside your team's existing documentation process. We can report an unresolved payer requirement without suggesting that a plan of care has been approved or that a certain number of visits will be paid.
06
Medicare therapy thresholds: general education
Original Medicare therapy rules differ from private insurance policies and Medicare Advantage plans. Medicare uses annual therapy threshold and targeted medical review concepts, but those thresholds are not visit caps or blanket authorization rules. Amounts and related guidance can change, so practices should confirm the current year's CMS publications. VerifyCallie can document available eligibility and benefit indicators, but does not determine Medicare compliance, the appropriate modifier, coverage of a specific treatment or medical necessity for your clinician.
07
A practical handoff for your front office
During onboarding, list the therapy disciplines your practice provides, relevant locations, approved provider NPIs, common payers and preferred report delivery. No patient details belong in the public inquiry form. Once agreements, a client BAA, portal access and security checks are complete, authorized clinic users will be able to submit requests through the secure workflow. The standard target is 24 to 48 hours, once we have everything we need. Difficult payer situations may take longer.