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

Every unit of Medicaid home care exists three times over. Once as an authorization, the payer's approval of specific units, dates, service codes, and a rate the agency is entitled to bill up to. Once as delivered care, the visit that actually happened, which for personal care is confirmed by an electronic visit verification record. And once as a billed claim, the submission the agency sent and the amount the payer actually paid on the remittance.

In a clean book, those three describe the same care and reconcile to the same number. In a real book they drift. A visit happens but never becomes a claim. A claim is sent but does not match the EVV record. A claim pays, but below the authorized rate. Each of those is a gap between two of the three records, and each gap is money. The trouble is that no single system in the agency shows the gap, because each system only holds one of the three records.

Every gap is a different loss

The value of separating the three records is that each pairwise gap has its own cause and its own fix.

• Delivered but not billed. A visit was authorized and happened and was EVV-confirmed, but no claim was ever created for it. This is revenue earned and never submitted. It is the quietest leak because nothing denies and nothing flags.
• Billed but not matching delivered. A claim went out but disagreed with the EVV visit on a field the payer checks, such as the date, the units, the service code, or the member ID, so it denied. The care happened; the claim failed on a technicality.
• Billed below authorized. A claim adjudicated and paid, but at a lower rate than the authorization allowed, usually a stale fee schedule or a modifier error. It never appears as a denial, so it is the hardest to catch.
• Delivered beyond authorized. Care was provided past what the authorization covered. This is not billable. It is a real cost to the agency, and an honest reconciliation flags it as a loss to prevent, never as a dollar to recover.

Underbilling is not the same as overdelivering

This distinction is the whole basis for an honest recovery number. Underbilling is delivering care inside the authorization and failing to collect for it. That is recoverable revenue, and it should be pursued. Overdelivering is providing care beyond the authorization. That is unbillable, a cost the agency absorbs, and it should be surfaced so it stops, not counted as money to be recovered. Any reconciliation that blurs the two will overstate what an agency can actually collect, which is exactly the kind of number that destroys trust the moment a biller checks it. The authorized ceiling is the honest cap on every recoverable figure.

How the three-way reconciliation is done

Reconciling the three records means matching them for a closed period, one client and one claim at a time:

• Pull the authorizations, the delivered and EVV-verified visits, and the submitted claims with remittances for the same closed period.
• Match delivered visits to claims: visits with no claim are unbilled revenue.
• Match claims to EVV records: mismatches are denials with a specific cause.
• Compare paid amount to the authorized rate: shortfalls are underpayments.
• Compare delivered units to authorized units: overage is unbillable cost, flagged separately.

Done manually, this means exporting from the EMR, exporting from the EVV system, gathering remittance advice, and cross-referencing them by hand. It is slow and it competes with the daily work of running an agency, which is why the gaps usually survive. For the specific failure modes, see unbilled visits, visit reconciliation, and EVV billing for home care. For the authorization side, see authorization tracking.

How Reeve does it, read-only

Reeve sits read-only over whatever EMR and EVV export an agency already runs, whether that is WellSky, AxisCare, HHAeXchange, AlayaCare, or another system. It performs exactly this three-way reconciliation on a closed period and returns a ranked list of recoverable dollars with the reason attached, every figure capped at the authorized ceiling and overage flagged separately rather than counted. Because it is read-only and neutral across every EMR, it never writes to your billing workflow without your control and has no reason to overlook a finding that implicates a billing module. For the broader map of revenue loss, see where home-care margin leaks, and for the recovery playbook, how agencies recover unbilled Medicaid revenue.

What the free Margin Teardown does

The way to see the gaps in your own book is to reconcile it. We run it on a real, de-identified slice of your own data, before you spend a dollar. The Margin Teardown is a one-time, read-only three-way reconciliation of a closed period: authorized against delivered against billed, with the gaps ranked and explained. It is free, and it is yours to keep whether or not you ever work with Reeve. It carries the same 3×-or-free guarantee the rest of the engine does. If Reeve does not surface at least three times its monthly fee in recoverable margin you agree is real, you do not pay.