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Home Health Care Claims Process


Step 1:  Claim Initiated & Information Collected
When you initiate a claim, it is assigned to a claim examiner and a nurse case manager. They will collect information from your physician, and a nurse from an independent company may also visit you to gather additional information.


Step 2:  Eligibility Review & Determination
The claim examiner and case manager will review all of the information received and evaluate your health condition, providers, and the services you are receiving to make sure they are covered under the terms of your policy. The case manager will call you to discuss your plan of care.


Step 3:  Notification
You will be informed by letter of the decision regarding the claim.


Step 4:  Processing of Covered Charges Incurred
If the claim examiner finds that all terms and conditions of the policy are met and all requested information has been received, the billing forms will be processed in accordance with the terms of the policy. Please remember to submit bills on a regular basis to avoid processing delays.

Case Management


Depending on your policy, you are assigned a case manager when you file a claim. Penn Treaty’s case managers are licensed health care practitioners who specialize in geriatrics. The case manager works with you and your physician to help develop a plan of care that outlines the type, frequency, amount and anticipated duration of the care that you may need.  The case manager can also provide information about community services and home care agencies. 


The case manager communicates with you by phone to discuss your care needs and changes in your health condition.  At times, the plan of care may be adjusted as your medical condition changes.