LCD-GROUNDED ELIGIBILITY · AUDIT-READY

Grow on the record.

Standard intake checks for one program per referral. For multi-service agencies, Guaranteed deploys AI agents that check every program a patient may qualify for and produce the documentation to defend every enrollment.

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REFERRAL → ELIGIBLE CARE

LIVE

8 new eligible enrollments in this batch. Captured automatically before intake review.

Why this exists

Fraud is real. So are the agencies caught in the net.

A small number of bad actors triggered every SSVI tier, every TPE round, every UPIC audit you're navigating today. The agencies that screen carefully and document thoroughly are spending the same effort defending the right answer.

Guaranteed is the paper trail that proves you weren't one of them.

SSVI Tier 1

• monitored continuously
• LCD-grounded
• every narrative, every time
• Audit cost: included, never billed extra

Read the full argument

AUDIT-READY RECORD

Patient 0294 · Hospice election · Day 47

• DEFENSIBLE
• LCD-grounded narrative

CLINICAL

• Day 1
• F2F encounter record
• HIECommonWell pull

ELIGIBILITY

• PAYER270 / 271 · Medicare A
• Day 1
• Election of Benefit

COMPLIANCE

• Patient signed, e-stored
• Day 1
• SSVI score history

COMPLIANCE

• 6 weekly snapshots
• Day 1 → 47
• Concurrent care check

CLINICAL

• No overlap, all four
• Day 1, 14, 28, 42

6 / 6 REQUIRED DOCS SSVI TIER 1 ASSEMBLED IN 47s

How it works

Three steps. Then it just runs.

STEP 01: INCOMING REFERRAL

• Margaret K. · 78
• via referral intake · Nov 06
• HHA referral CHF

Connect

EMR + referral inbox. We sit alongside what you already use. No migration required.

STEP 02: ELIGIBILITY · 0294 LIVE

• Hospice ✓ ELIGIBLE
• GUIDE ✓ ELIGIBLE
• Palliative ✓ ELIGIBLE
• HHA ✓ ELIGIBLE
• PCS N/A

Verify

Real-time licensed-data lookups against every serious-illness program, for every patient.

STEP 03: LCD-GROUNDED NARRATIVE

• // L33393 · HOSPICE / DEMENTIA
• FAST 7c ✓
• BMI <21 ✓
• Decline 8%/6mo ✓
• ELIGIBLE · auto-documented

Defend

Every eligible decision lands in your queue with the LCD-grounded narrative your audit team needs.

The platform

One platform. Four ways forward.

Eligibility identification, fraud protection, documentation quality, and network risk in a single layer that sits alongside your EMR. Grow your services without growing your exposure.

01 GROWTH - Eligibility identification
02 DEFENSE - Audit-ready paper trail
03 HOSPICE - SSVI monitoring + compliance agents
04 NETWORK - Partner intelligence network

GROWTH · CAPABILITY 01

Eligibility identification

Every referral screened against hospice, palliative, GUIDE, HHA, and PCS. Records retrieved, insurance verified (Medicare, Medicaid, commercial), benefit periods returned, and out-of-pocket exposure flagged on intake day.

NEW REFERRAL · 0294-MK

• Margaret K. · 78 · referred today via referral intake

SCREENED IN 12s

• PRIMARY: Medicare A + B
• ✓ active

BENEFIT PERIOD

• 1st 90-day
• fresh · 0 used

OUT-OF-POCKET

• $0 · Medicare
• no copay flagged

ELIGIBLE PROGRAMS · 3 OF 5

• Home Health: Homebound · F2F documented · skilled need ✓ ELIGIBLE
• Palliative: Serious-illness criteria met · outpatient ✓ ELIGIBLE
• GUIDE: Dementia dx confirmed · in service area ✓ ELIGIBLE
• Hospice: Curative tx active. Not yet eligible. N/A
• PCS: Outside service area N/A

Records retrieved · insurance verified. Full chart pulled from HIE, attached to admission packet. Re-screen flagged when curative treatment ends.

Outcomes

What partners see in their first 90 days.

• -1068% faster identification of program eligibility
• -570%+ reduction in time spent on patient intake
• -214% increase in identification of eligibility

Built for the whole team

AI agents that work the queue alongside your team.

Cut intake cost. Cut no-shows. Cut audit prep. Agents deploy automatically when something needs doing, so your team only sees the decisions, not the busywork.

FOR INTAKE

• < 90s avg screen + verification
• −47% no-show rate at admit

Intake & Referrals

AI agents work the queue before your team does. Screening every referral, calling for missing records, and confirming insurance the moment the fax lands.

AGENTS

• Retrieves full patient records from HIE
• Verifies Medicare, Medicaid + commercial (free, unlimited)
• Returns benefit periods + out-of-pocket flags
• Confirms F2F + schedules admit

FOR CLINICAL

• 24/7 continuous re-evaluation
• 100% LCD-grounded narratives

Clinical Leadership

Continuous re-screening as condition changes. When a patient becomes hospice-eligible mid-HHA episode, your clinical team sees it before the next visit.

AGENTS

• Re-screens on condition change
• Drafts clinical summary + trajectory
• Flags concurrent-care opportunities

FOR COMPLIANCE

• 47s avg audit packet generation
• 6 / 6 required docs auto-filed

Compliance & Audit

Agents deploy the moment an SSVI score crosses tier, or any oversight paperwork requirement triggers. Pulling records, generating LCD-grounded narratives, and assembling the response packet.

AGENTS

• Monitors SSVI tier in real time
• Builds audit packet end-to-end
• Pre-fills EOB, DNR, F2F, OST

How we fit

Works alongside your EMR.

No EMR integration required to start. Your team keeps working in the system they already use; Guaranteed runs in parallel, returns eligibility decisions, and hands back bill-ready documentation.

Direct EMR integrations are on the roadmap. Today, most agencies onboard without one.

AGENCIES USE GUARANTEED ALONGSIDE

Works alongside your existing EMR — no migration, no IT lift.

No-IT-lift onboarding. Upload (or we ingest) referrals → eligibility decisions return in your queue → bill-ready narratives flow back to your team. The EMR is untouched.

See what you've been missing

See every patient you've been missing.

We'll replay your historical referrals through Guaranteed and show you the patients that qualified, the ones you missed, and the documentation we would have built. No commitment.

30-MINUTE WALKTHROUGH

What you leave with

• A live walkthrough of the platform in your service line
• Your cost modeled line by line at real volume
• A live eligibility screen on a sample patient — so you see exactly what Guaranteed finds

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