How does a long-term care insurance policy start paying?

When the policyholder meets the policy's benefit trigger, most often being expected to need help with two activities of daily living for 90 days or having a cognitive impairment, and has served the elimination period, the days of care the policyholder pays for before benefits begin. Nothing is paid for care before both are met, which is why the policy is checked before the first visit.

What does the carrier need with each claim?

Typically an invoice showing the dates, hours, caregiver and rate for each visit, care notes or a plan of care, and sometimes signed timesheets, on the carrier's form or portal. Each carrier has its own list, and a claim with one item missing waits until it arrives.

Can the carrier pay the agency directly?

Many policies allow an assignment of benefits so the carrier pays the agency; some pay only the policyholder, who then pays the agency. The policy says which, and the answer decides whether you are billing a carrier or invoicing a client with the carrier's paperwork attached.

Why was a claim denied when the client has a policy?

The usual reasons: the elimination period was not yet satisfied, the agency does not meet the policy's licensing or certification definition, the service is not a covered type, the daily or monthly benefit is exhausted, or a required document is missing. Each one is avoidable with the policy read in advance.

How do you keep track of the benefit balance?

Most policies pay up to a daily, weekly or monthly limit and cap the total at a maximum lifetime benefit. The biller records both at verification and reduces the balance as claims are paid, so the family hears about the end of benefits before the last covered visit, not after.

What do you need from an agency to start?

A signed BAA, a user for your biller in your agency software, the policy and carrier details for each insured client with the client's authorization to speak to the carrier, and your invoicing cycle. Bring an aging report to the review if you have one.

Long-Term Care Insurance Billing for Home Care

Long-term care insurance billing for home care agencies

Long-term care insurance billing is carrier-by-carrier work: each policy has its own benefit trigger, elimination period, daily, weekly or monthly limit, definition of an eligible agency and list of documents it wants with every claim.

Remitwright gives agencies a dedicated biller who verifies the policy before the first visit, submits each claim the way that carrier wants it, chases it to payment, and tracks the benefit balance so the family hears about the end of benefits before the last covered visit.

Last reviewed October 21, 2026 by the Remitwright billing team. Editorial policy

How the policies work

Long-term care insurance is a private product overseen by state insurance regulators, and the policies sold over the years differ widely in what they cover and how.¹ It is one of the funding sources a home care billing service has to handle alongside waiver, VA and private pay. For an agency, the parts that matter are the same on every policy, even when the answers differ:

The benefit trigger. Most often, being expected to need help with two of the six activities of daily living for at least 90 days, or a cognitive impairment that calls for supervision.²
The elimination period. Days of care the policyholder pays for before benefits start. Some policies count every calendar day the trigger is met, others count only days of paid service; the difference changes when the first claim can be paid.²
The benefit amount. A daily, weekly or monthly limit, sometimes with inflation protection, and in most policies a maximum lifetime benefit that each paid claim draws down.²
Who may provide care. Some policies pay only for care from a licensed provider or agency; others also pay for home care aides who are not licensed.²
How benefits are paid. Most policies sold today pay expense-incurred benefits, to the policyholder or the provider, up to the limit; indemnity policies pay a set amount to the policyholder whatever the cost.² Whether the carrier pays the agency directly decides who you bill.

Before the first visit

With the client's authorization, the biller calls the carrier and records the trigger, the elimination period and how it is counted, the benefit amount and remaining pool, the agency definition, the covered services and the claims process.
The agency checks that it meets the policy's definition of an eligible provider. If it does not, the family hears that before care starts.
The assessment the carrier needs to open the claim is scheduled, and the claim is opened with the carrier.
The family understands what they will pay during the elimination period and after the benefit runs out.

What goes with every claim

Carriers differ, but most want an invoice listing each visit with its date, hours, caregiver and rate; care notes or a plan of care for the period; and, for some, signed timesheets and a current assessment. Submission is through a portal, by fax or by mail depending on the carrier, and a claim with one document missing waits until it arrives. The biller keeps a checklist per carrier and sends complete claims on the cycle the carrier pays on.

Why claims are denied

The elimination period was not yet satisfied, or was counted differently from how the family understood it.
The agency does not meet the policy's eligible-provider definition.
The service type is not covered, such as homemaker-only visits under a policy that pays for personal care.
The daily, weekly, monthly or lifetime benefit is exhausted.
A required document is missing or the assessment has expired.

The routine

Policy details recorded at verification and rechecked at each renewal or assessment date.
Claims submitted on each carrier's cycle with its checklist complete, and chased at the carrier's stated turnaround.
Payments posted against the invoice and the benefit balance, with short payments queried.
Balance and remaining pool reported to the family on a schedule they agree, with notice well before benefits end.
Private pay invoicing for the elimination period and for anything the policy does not cover.