💳 Payors & Risk

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💳Module 4 · Slide 10

Payors — Who Pays for Home Infusion?

This is where things get nuanced, and it's something you'll need to understand cold. We deal with four main payor types, each with different rules, reimbursement rates, and requirements.

Payor Overview

Commercial Insurance	Best reimbursement, per diem model, site-of-care optimization opportunity	Primary Growth Target
Medicare Part B	Covers pump-based drugs, professional services; limited formulary	Limited Scope
Medicare Part D	Specialty pharmacy drugs, works like commercial pharmacy benefit	More Relevant for IFH
Medi-Cal (Medicaid)	California Medicaid — our bread and butter, unique auth requirements	Primary Payor

⭐ Medi-Cal is Our Bread and Butter

In California, Medi-Cal is our primary payor. Our expertise in Medi-Cal authorization requirements, MCO carve-outs, and monthly eligibility management is a real competitive advantage. Use it.