Operator Playbook

Payer-Call Verification Playbook
Five payers. One call-flow.

The exact call-flow ScriptRelay operators use to verify insurance with Medicare, Aetna, UnitedHealthcare, Humana, and Cigna. Five dialogue scripts — plus the escalation shortcut for when the rep stops being useful.

Medicare Aetna UnitedHealthcare Humana Cigna
Inside the playbook

Three steps of an actual call

Call Sheet · Step 1–2 UnitedHealthcare
1
Greeting
2
Member ID
Call Sheet · Step 3–4 Aetna
3
Diagnosis / HCPCS
4
Coverage
Call Sheet · Step 5–6 Humana
5
Auth / Referral
6
Callback Confirmation

Each payer card below spells out the full six-beat script and escalation block — print it, pin it, run it live from the demo.

The five payer cards

Use the right number. Use the right script.

Each card includes the intake line, the six-step dialogue, and the escalation path. Numbers below are payers' published general-verification lines; always confirm on the portal for your specific region/LOB before relying on them in production.

Payer 01
Medicare — DME PSC
Durable Medical Equipment regional Program Safeguard Contractors · Eligibility & CMN status
Intake Line
866-311-9161
Verification Script
  1. 1
    Greeting
    You:"Hi, this is [your name] calling from [DME company] on behalf of a Medicare beneficiary. I'd like to verify DME coverage and check CMN / order status — is this the provider line for Medicare DME?"
    Rep:(Confirms they handle DME/provider inquiries; routes you accordingly.)
  2. 2
    Member ID
    You:"The beneficiary's MBI is [MBI], DOB [date], last name [name]. Can you confirm eligibility is active today?"
    Rep:(Pulls eligibility — Part A/B active dates, MSP if any, hospice/ESRD flags.)
    If the MBI is not in their system, ask for the 11-digit MBI from the patient card — Medicare replaced HICNs in 2020.
  3. 3
    Diagnosis + HCPCS
    You:"The diagnosis is [ICD-10], and we're providing HCPCS [code] — let me spell the code: [alpha-numeric]. Is that a covered benefit under the relevant LCD, and is the order signed and dated within the last six months?"
    Rep:(References the LCD / NCD; confirms the HCPCS is payable for the diagnosis.)
    For oxygen (E1390), confirm the CMN is on file and the most recent retest is within 90 days; for CPAP (E0601), confirm the sleep study is < 12 months old.
  4. 4
    Coverage
    You:"What's the beneficiary's deductible status on Part B for this calendar year, and is the 20% coinsurance the only patient responsibility? Any supplier standards or competitive bid area (CBA) restrictions on this HCPCS in this ZIP?"
    Rep:(Quotes deductible met-to-date, remaining, and any CBA / single payment amount rules.)
  5. 5
    Auth / Referral
    You:"Does this HCPCS require a prior authorization under the recent CMS DME prior auth program, or is a written order from the treating practitioner sufficient? If a PA is required, what documentation — face-to-face notes, LCD criteria checklist — do you need on submission?"
    Rep:(Tells you whether PA applies and what they need.)
    As of 2024–2026 the CMS DME Prior Auth program covers 16 codes including K0856/K0861 (power wheelchair), E1390 (oxygen), L0631 (LSO). Confirm PA status specific to date of service.
  6. 6
    Callback Confirmation
    You:"To confirm — eligibility is effective [date], the HCPCS is payable per [LCD], deductible status is [met / $X remaining], PA is [required / not required], and next step is [our action]. Could I get a reference number for this call and the rep's name?"
    Rep:(Provides reference number — write it down; it's the only way to escalate.)
Escalation Block — Medicare DME PSC
Supervisor line
Ask the rep to "transfer to the DME provider supervisor" without hanging up. If they refuse, call back and dial the supervisor menu explicitly. PSC escalation paths differ by jurisdiction (Noridian, CGS, Palmetto, WPS).
Portal reference
Use the PSC's provider portal (myCGS, Noridian Medicare Portal, Palmetto GBA, etc.) — file a written "provider inquiry" within 30 days citing the call reference #. Keep screenshots of every web submission.
Turnaround
Eligibility: same call. Auth (when applicable): 5–10 business days, up to 30. Redetermination (Level 1 appeal): 60 days to file, 60-day decision window.
Payer 02
Aetna
Provider Services · Commercial + Medicare Advantage DME
Intake Line
888-632-3862
Verification Script
  1. 1
    Greeting
    You:"Hi, this is [your name] at [DME company]. I need to verify benefits and obtain a precertification for DME on an Aetna member. Can you connect me to the DME / medical precert queue?"
    Rep:(Confirms queue, or routes to general provider services.)
  2. 2
    Member ID
    You:"Member ID is [Aetna ID], group [number] on the card, patient name [name] DOB [date]. Can you confirm active coverage today and the plan type — commercial PPO/HMO, or Medicare Advantage?"
    Rep:(Confirms eligibility, plan, in/out-of-network status.)
  3. 3
    Diagnosis + HCPCS
    You:"Diagnosis ICD-10 is [code]. HCPCS code is [code] for DME. Is this a covered benefit under the member's plan, and is a written order / Certificate of Medical Necessity on file sufficient or do you require something additional?"
    Rep:(References coverage policy; flags any exclusions.)
  4. 4
    Coverage
    You:"What is the member's deductible and coinsurance/copay for DME under this plan? Frequency limits on replacement units? Any annual or lifetime maximums on this category?"
    Rep:(Reports cost-share, frequency limits, and any plan maximums.)
    Aetna plans vary widely (employer fully-funded, ACA individual, MA). Always cite plan type — the answer to "is CPAP covered" can flip on it.
  5. 5
    Auth / Referral
    You:"Is precertification required for HCPCS [code]? If yes, can you initiate it on this call, or do you need a separate submission through the Availity portal? What clinical documentation — face-to-face notes, sleep study, MSRP — does Aetna require for medical necessity?"
    Rep:(Tells you if precert is needed; routes to precert team or portal.)
  6. 6
    Callback Confirmation
    You:"Recap — coverage is active, plan is [type], benefit is [covered / not covered], cost-share is [amount], precert is [obtained / pending / not required], and our next step is [action]. Can I get the precertification number if applicable, and a call reference ID?"
    Rep:(Issues precert number / reference ID — record both.)
Escalation Block — Aetna
Supervisor line
Ask the rep: "Can I speak with a clinical supervisor or your team lead on this case?" If they decline, end the call politely and call back requesting the supervisor queue by name (most Aetna queues route to a lead after 5–7 min hold).
Portal reference
Availity (availity.com) — Aetna uses it for eligibility, claims, and auth inquiries. Open a "case" whenever a phone rep gives you a verbal answer; the case ID is what survives an audit.
Turnaround
Eligibility: same call · Precert: 24–72 hours (urgent: same day) · Appeal: 60 days from EOB · External review: 4 months after final internal denial.
Payer 03
UnitedHealthcare (Optum)
Provider Services · Commercial + UHC Medicare Advantage DME
Intake Line
877-842-3210
Verification Script
  1. 1
    Greeting
    You:"Hi, this is [your name] at [DME company]. I'm calling to verify benefits and obtain prior authorization for DME on a UnitedHealthcare member. Could you route me to the DME / home health prior auth line?"
    Rep:(Confirms queue, may ask if "commercial or Medicare Advantage" first.)
    UHC segregates MA into a separate queue — say "Optum" if you get bounced; their DME-services arm is Optum.
  2. 2
    Member ID
    You:"Member ID [UHC ID], group [number] if commercial, member name [name], DOB [date]. Confirm active coverage and plan type — commercial PPO/HMO/EPO, UHC Medicare Advantage, or a community/Medicaid plan?"
    Rep:(Pulls eligibility, plan, in-network status, care provider assignment if HMO.)
  3. 3
    Diagnosis + HCPCS
    You:"Diagnosis ICD-10 is [code]; HCPCS code is [code]. Is this HCPCS payable under this plan for this diagnosis? Does UHC require a specific LCD or internal coverage policy we need to attach for medical necessity?"
    Rep:(Cites UHC's medical policy.)
  4. 4
    Coverage
    You:"What's the member's deductible, coinsurance, and out-of-pocket max for this benefit year? Any frequency limit on replacement units for this HCPCS, and is there a rental-vs-purchase cap difference?"
    Rep:(Reports cost-share and any plan limits.)
  5. 5
    Auth / Referral
    You:"Does this HCPCS require prior authorization through the UnitedHealthcare Provider Portal, or can we submit through Optum's auth portal? What is the standard turnaround, and what clinical documentation (face-to-face, sleep study, MSRP, AOB) do you need?"
    Rep:(Confirms PA requirement and required documents.)
  6. 6
    Callback Confirmation
    You:"Recap — coverage active, plan is [type], HCPCS payable per [policy], cost-share is [amount], PA is [obtained / pending / not required], next step is [action]. Please issue a prior authorization number if PA was obtained, and provide a call reference number for this conversation."
    Rep:(Issues PA number or case ID.)
Escalation Block — UnitedHealthcare
Supervisor line
Say: "I need to escalate this to a clinical peer reviewer per our prior auth process." UHC will route to a peer-to-peer review within 24–48 hours for MA precerts and 5 business days for commercial.
Portal reference
UHC Provider Portal (uhcprovider.com) under "Prior Authorization and Notification" — every verbal decision should be supplemented by a written portal case to create a paper trail.
Turnaround
Eligibility: same call · Precert: 24–72 hours · Peer-to-peer review: 24–48 hours · Appeal (Level 1): 60 days from EOB.
Payer 04
Humana
Provider Services · Commercial + Medicare Advantage DME
Intake Line
800-448-6262
Verification Script
  1. 1
    Greeting
    You:"Hello, this is [your name] at [DME company]. I'd like to verify DME benefits for a Humana member and check prior auth status. Is this the right queue for DME / home medical equipment?"
    Rep:(Confirms queue; may transfer to a DME specialist for MA.)
  2. 2
    Member ID
    You:"Member ID [Humana ID], member name [name], DOB [date]. Confirm active coverage and plan type — Humana commercial or Humana Medicare Advantage / HumanaChoice?"
    Rep:(Pulls eligibility, plan, PCP assignment if HMO.)
  3. 3
    Diagnosis + HCPCS
    You:"Diagnosis ICD-10 is [code]; HCPCS is [code]. Is this a covered benefit under the member's plan for this diagnosis? Any required documentation — Certificate of Medical Necessity, written order, F2F encounter — specific to Humana's coverage criteria?"
    Rep:(References Humana's medical coverage policy; cites required docs.)
  4. 4
    Coverage
    You:"What is the member's deductible status on this plan and coinsurance for DME? Any frequency or replacement limits specific to this HCPCS, and does Humana treat it as capped rental or purchased?"
    Rep:(Reports cost-share, rental vs. purchase treatment, frequency limits.)
    Humana MA plans follow CMS capped-rental rules (13 months) for many DME items; commercial plans usually convert to purchase at delivery.
  5. 5
    Auth / Referral
    You:"Is a prior authorization required for this HCPCS? If yes, can we submit it via Availity or the Humana provider portal? What clinical documentation is required and what is the expected turnaround?"
    Rep:(Confirms PA requirements and submission path.)
  6. 6
    Callback Confirmation
    You:"Recap — coverage active, plan is [type], HCPCS payable per [policy], deductibles and coinsurance to collect are [amount], PA is [obtained / pending / not required]. Please issue a prior authorization / case number, and provide this call's reference ID."
    Rep:(Provides PA / case number and reference ID.)
Escalation Block — Humana
Supervisor line
Ask: "Can I escalate this to a peer reviewer or your provider relations rep?" Humana uses peer-to-peer for MA denials and has a dedicated provider-relations line for systemic issues.
Portal reference
Humana Provider Portal (availity.com partnership) — every verbal confirmation should generate a written case to survive appeal. Note the case ID communicated in the call.
Turnaround
Eligibility: same call · Precert: 24–72 hours · Peer-to-peer: 24–48 hours · Reconsideration (Level 1): 60 days.
Payer 05
Cigna (Evernorth)
Provider Services · Commercial + Medicare Advantage DME
Intake Line
800-882-4462
Verification Script
  1. 1
    Greeting
    You:"Hi, this is [your name] at [DME company]. I'd like to verify coverage and check prior authorization requirements for DME on a Cigna member. Is this the DME / medical precert team?"
    Rep:(Confirms queue or routes to DME-specific support.)
  2. 2
    Member ID
    You:"Cigna member ID [ID], member name [name], DOB [date]. Confirm eligibility and plan type — commercial, Cigna Medicare Advantage, or Evernorth-administered?"
    Rep:(Pulls eligibility, plan, network status.)
  3. 3
    Diagnosis + HCPCS
    You:"Diagnosis ICD-10 is [code]; HCPCS code [code]. Is this HCPCS payable under the member's plan for this diagnosis? Any additional documentation — Certificate of Medical Necessity, signed order within six months, F2F, sleep study — required by Cigna for medical necessity?"
    Rep:(Cites Cigna's medical coverage policy.)
  4. 4
    Coverage
    You:"Deductible and coinsurance for DME under this plan? Any frequency or replacement limits? Is this item a capped rental under CMS rules, or does Cigna convert to purchase on delivery?"
    Rep:(Reports cost-share and rental/purchase treatment.)
  5. 5
    Auth / Referral
    You:"Is prior authorization required for HCPCS [code]? If yes, can we begin the request on this call, or does it need to go through the provider portal? What documentation and turnaround can we expect?"
    Rep:(Confirms PA submission path and requirements.)
  6. 6
    Callback Confirmation
    You:"Recap — coverage active, plan is [type], HCPCS payable per [policy], cost-share is [amount], prior auth is [obtained / pending / not required]. Please issue a prior authorization number if available, and give me the call reference ID for this conversation."
    Rep:(Provides PA / case reference ID.)
Escalation Block — Cigna
Supervisor line
Ask for "a peer review or supervisor" if the rep is unable to authorize. Cigna uses peer-to-peer for clinical denials; have the ordering physician's contact ready.
Portal reference
CignaforHCP (cignaforhcp.com) or the Evernorth Care portal — every verbal decision should be backed by a written case. Use it for eligibility 270/271 responses and appeal submissions.
Turnaround
Eligibility: same call (or 270/271 in < 1 min) · Precert: 24–72 hours · Peer-to-peer: 24–48 hours · Appeal: 60 days from EOB.
Run this from the demo. Every script on this page maps to the Verify Insurance step in the live order-detail flow — open an order in the demo to paste the rep's answers and capture the auth / reference number automatically.
Open demo order

Phone numbers above are payers' published general-verification lines. They change occasionally, and certain lines route by region/LOB. Always confirm the right number for your specific contract on the payer's provider portal before relying on it in production. The dialogue scripts are starting points — adapt to your rep's prompt style and your state's payer nuances.

How to use this playbook

The right way to run these scripts

Print and pin it near the verification desk

Tape the right payer card to the wall where your CSRs pick up the phone. When the rep asks a question, the answer is already visible.

Pair with the denial-code handbook after the call

A verification that ends in a denial still needs an answer. The denial handbook covers the CARC codes the rep will quote — root cause, fix workflow, sample appeal language.

Run it live from the demo Verify Insurance flow

Open an order in the demo, click Verify Insurance, and paste the rep's answers as you go — the demo captures eligibility, deductible, and auth status in real time.