Healthcare Eligibility Check

Beneficiary Full Name*

Beneficiary Date of Birth*

Date of Birth For Beneficiary

Medicare Beneficiary Identifier*

11-Character Medicare ID found on Medicare Card (cannot contain S, L, O, I, B, Z)

Does Beneficiary need help managing daily activities, specifically handling finances or personal care?*

Yes

Does Beneficiary reside in a Skilled Nursing Facility?*

Yes

SNFs offer round-the-clock certified nursing support, usually for individuals needing continuous therapeutic or medical treatment.

Is Beneficiary currently receiving GUIDE services?*

Yes

Select 'No' if patient is not enrolled in GUIDE

Your Phone Number*

Your Email*

I agree to the Privacy Policy and allow Crosby Health to submit my information to check for eligibility for the GUIDE model.