Initial Onboarding Documentation Checklist - Home Health Agency

Credentialing Client Discovery Form

(Home Health Agency Licensing, Accreditation & Credentialing)

Purpose:

This form focuses on gathering information on existing billing operations, transition readiness, A/R, denials, reporting, and ongoing revenue-cycle support.

EHR/PM software, clearinghouse, payer portal access, and active payer enrollments are expected to be already established.

Instructions:

• Complete every applicable field. Select only services currently provided or planned.

• Upload supporting documents through the secure upload fields. Do not email protected or sensitive documents.

• Items marked “if applicable” may not apply to every provider or practice. Upload documentation through the secure portal only.

Agency Information

1. Business and Tax Verification

2. Ownership and Signing Authority

3. Parent Company / Holding Company / Affiliated Entity Information, If Applicable

Is the agency owned by a parent company, holding company, management company, or affiliated entity?

4. NPI / NPPES Verification

5. State Licensure Information

Please complete a separate entry for each state license, registration, certification, approval, pending application, or license type that applies or may apply to your agency.

This may include home health, home care, home services, home nursing, personal care, private duty nursing, companion/homemaker services, hospice, or other state-required agency licenses.

6. Location / Office Documentation

7. Service Scope / Home Health Services

Services the agency currently provides
Please also confirm
Services the agency plans to provide
Please also confirm
Patient / payer types served

8. Administrator, Clinical Leadership, and Key Personnel

9. Medicare, Medicaid, and Payer Enrollment Status

10. Insurance and Bonding

11. Record Storage / EHR System

Please complete this section so we can understand how patient/client records, business records, accreditation documents, and compliance documentation are stored and maintained.

11.1 Do you currently use an EHR, EMR, billing system, CRM, or other software system to store patient/client records?
Current system status
Which disciplines currently document in the system?
11.2 What types of records are stored in the system?
11.2 Record Location Detail: Select all locations that apply for each record type. Use “Not Currently Documented / Not Yet Implemented” when the item should apply but is not yet maintained. Use “N/A” only when it truly does not apply.

A. Clinical Record Documentation

Record / Documentation TypeEHR / EMRPaper FileExcel / SpreadsheetBilling SystemShared Drive / Cloud FolderOther System / PortalNot Currently Documented / Not Yet ImplementedN/A
Patient/client intake or referral records
Admission packet / admission documents
Patient rights and responsibilities acknowledgment
Consent forms / service agreements
OASIS privacy notice, if applicable
Comprehensive assessment
Start of care assessment
Resumption of care assessment
Recertification / follow-up assessment
OASIS documentation, if applicable
OASIS submission / correction / rejection records, if applicable
Plan of care / care plan
Plan of care updates / revisions
Plan of care signature / approval tracking
Certification / recertification tracking
Orders / physician or allowed practitioner documentation
Verbal orders
Signed order tracking
Skilled nursing visit notes
Physical therapy visit notes
Occupational therapy visit notes
Speech therapy / speech-language pathology visit notes
Home health aide / non-skilled visit notes
Therapy evaluations / reassessments, if applicable
Medication profile / medication reconciliation, if applicable
Patient/client communication notes
Care coordination notes
Case conference / interdisciplinary communication notes
Change in condition documentation
Missed / refused / rescheduled visit documentation
Patient/caregiver education documentation
Patient/caregiver written instructions
High-risk patient / emergency preparedness profile
Transfer documentation
Discharge documentation / discharge summary

B. Scheduling, Payer, Billing, and Operational Records

Record / Documentation TypeEHR / EMRPaper FileExcel / SpreadsheetBilling SystemShared Drive / Cloud FolderOther System / PortalNot Currently Documented / Not Yet ImplementedN/A
Scheduling records
Insurance / payer information
Prior authorization documents
Billing / claims information
Denial tracking / denial follow-up records
Financial audit reports / billing audit documentation
Vendor records / vendor evaluations

C. Compliance, QAPI, Personnel, and Administrative Records

Record / Documentation TypeEHR / EMRPaper FileExcel / SpreadsheetBilling SystemShared Drive / Cloud FolderOther System / PortalNot Currently Documented / Not Yet ImplementedN/A
Complaint / grievance records
Incident / adverse event records
Abuse / neglect reporting records, if applicable
Infection control / exposure records
Emergency preparedness program documents
Release of information / disclosure tracking
HIPAA / compliance documents
Breach / security incident records
Personnel records
Training records
Policies and procedures
Policy review records
Leadership meeting minutes
QAPI / performance improvement documents
Corrective action records
Audit tools / audit reports
Documentation audit reports or worksheets
Other: __________________________
11.2A OASIS System Capabilities

If OASIS applies, select all capabilities supported by the system.

11.3 If you do not use an EHR or software system, how are records currently stored?
11.4 Where are patient/client records stored?
11.5 Can records be exported, printed, or downloaded for accreditation review if needed?
Which items can be exported, printed, or downloaded?
11.6 EHR Reporting/Audit Capability

Can the system generate reports for any of the following?

11.7 Electronic System Security / Access Controls

Complete this section for any electronic system used to store or access patient/client, personnel, billing, compliance, QAPI, or agency records.

11.8 Paper / Physical Record Safeguards

Complete this section if the agency maintains paper files, printed records, physical binders, hard-copy personnel files, paper clinical records, logs, or other physical documentation.

12. Vendor / Contractor / Outside Service Information

Complete one entry for each vendor, contractor, consultant, software company, billing company, staffing agency, therapy contractor, medical supply vendor, laboratory, pharmacy, or other outside entity involved in agency operations or patient care.

Common vendor / contractor examples

13. Existing Accreditation-Related Materials

14. Initial Patient Record / Census Status

15. Authorized Official / Signing Authority

Identify the individual authorized to sign official documents on behalf of the agency.

Relationship to the agency
What is this person authorized to sign or approve?
Project Contact, If Different

Authorized Official Signature

Complete the authorized official information above, then either draw the signature or upload a signed signature file.

Use either the signature pad or upload a signature image/document.

Accepted formats: PDF, JPG, JPEG, or PNG.

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Thank You!

Your Home Health Agency Licensing, Accreditation & Credentialing Client Discovery Form has been submitted successfully.

Your form is currently in review.

Our Credentialing team will review your information and supporting documentation and contact you if additional information is required.

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