What is the auth-to-claim gap?

The difference between what a payer approved, what was delivered, and what was billed and paid. Each gap is a distinct loss with a distinct fix.

Why are unbilled hours easy to miss?

An unbilled visit produces no remittance line, so nothing on any standard report rejects or alerts. It stays invisible until the filing window closes.

What is a silent underpayment?

A claim that posts and pays, but at a rate lower than the contracted rate for that code. No denial fires, so it looks like a normal payment on the aged AR.

How does the authorized ceiling cap recovery?

Recoverable dollars are calculated as the lesser of delivered and authorized units at the contracted rate. Anything delivered above the authorization is unbillable cost and is reported as exposure, not recovery.

Is my data safe when running a review?

Yes. The Margin Review is read only and replaces client names and Medicaid IDs with a coded reference locally in the browser before analysis. Your file is processed in your browser, and no name is written into any output.

ReevePillar guideThree-way reconciliation

Authorized, delivered, billed: the three numbers that should match, and usually don't.

Every Medicaid home-care visit lives in three separate records. A payer authorization sets what was approved. An EVV log captures what actually happened. A claim and remittance record what was billed and paid. In a clean world the three agree. In practice they drift, and the drift is where margin quietly leaves the building.

The three records

Authorized is the payer-approved ceiling for a member. It fixes the units, the date range, the service code, and the rate. Nothing above that ceiling is billable, no matter how much care was delivered.

Delivered is what actually happened at the point of care, confirmed by EVV under the 21st Century Cures Act. It is the ground truth for time, place, and caregiver.

Billed and paid is what the agency submitted on a claim and what the payer actually remitted. The remittance is the only record that carries a dollar amount you can bank.

Every gap is a different loss

›Delivered but not billed. Care happened, wages went out, no claim was ever submitted. Earned revenue, unsubmitted.
›Billed but not matching delivered. A field on the claim, date, units, service code, member ID, does not match the EVV record, and the payer denies.
›Billed below the authorized rate. The claim posts, the remittance is lower than the contracted rate for that code, and no denial fires to warn you.
›Delivered beyond the authorized ceiling. Unbillable cost the agency absorbs. It is exposure, not recovery, and should be flagged so it stops.

Underbilling is not overdelivering

Underbilling is care that stayed inside the authorization but was never turned into collected cash. It is recoverable inside the filing window.

Overdelivering is care beyond the authorization. It is unbillable cost you should stop, not revenue you can chase. The authorized ceiling caps every recoverable figure on the report; anything above it is compliance exposure and is never counted as recovery.

How three-way reconciliation works

01
Pull one closed period
Authorizations, EVV visits, claims and remittances
One closed billing month is enough. Authorization summary, EVV visit detail, and the claim status or 835 remittance for the same window.
02
Match delivered to claims
Find unbilled
Every EVV-verified visit that has no corresponding claim line is a candidate for an unbilled recovery inside the filing window.
03
Match claims to EVV
Explain the denials
For each denial, compare the claim fields against the EVV record. Most denials trace back to a date, unit, code, or member ID that does not line up.
04
Compare paid vs authorized
Find silent underpayments
Divide paid dollars by billed units per code and compare against the contracted rate. Anything materially below is a silent underpayment.
05
Flag over-authorized delivery
Exposure, not recovery
Isolate visits that ran beyond the authorized ceiling. Report as compliance exposure so it can be fixed upstream. Never count it as recoverable dollars.

How Reeve does it

Reeve is a read-only Margin Review over your own EMR and EVV exports. It is EMR-neutral, so the same review runs across WellSky, AxisCare, HHAeXchange, and AlayaCare.

The output is a ranked list of recoverable dollars, every line tied to a reason and to the authorized ceiling that caps it. Name coding runs locally in the browser before any analysis; your file is processed in your browser, and no name is written into any output. The first review is free on a closed period.

Questions

Plain answers, on the record.

: The difference between what a payer approved, what was delivered, and what was billed and paid. Each gap is a distinct loss with a distinct fix.
: An unbilled visit produces no remittance line, so nothing on any standard report rejects or alerts. It stays invisible until the filing window closes.
: A claim that posts and pays, but at a rate lower than the contracted rate for that code. No denial fires, so it looks like a normal payment on the aged AR.
: Recoverable dollars are calculated as the lesser of delivered and authorized units at the contracted rate. Anything delivered above the authorization is unbillable cost and is reported as exposure, not recovery.
: Yes. The Margin Review is read only and replaces client names and Medicaid IDs with a coded reference locally in the browser before analysis. Your file is processed in your browser, and no name is written into any output.

Collect is money you never captured. Cover is money a payer can still take back.

Reeve reports the two separately and never adds them together, because only one of them is yours to go and get. The Margin Review reads both on your own export and costs nothing.

Margin Review

Free

One pass over your own export, in your browser. The findings are yours to keep, with no obligation.

Collect

$750 per branch per month

The recovery lane. Care you delivered and never billed, units short of what was authorized, lines paid under the published rate.

Cover

$1,000 per branch per month

Everything in Collect, plus the exposure lane. Retired codes, authorizations at the end of their period, care delivered past what was approved.

Month to month, no annual contract. Read-only in every tier. Run the free review.

Start with a Margin Review

See your three numbers, lined up.

Export a single closed month from your EMR and EVV. The review lays authorized, delivered, billed, and paid side by side and shows the gaps in ranked dollars.

Start my free Margin Review