California home care margin recovery.
You delivered the care and CalEVV recorded it.
This is the read-only way to find the visits that never turned into a clean, paid claim, before California's six-month filing clock takes a cut.
Every home care agency in California is really running four columns that are supposed to agree and almost never do.
The hours and units your payer signed off on. In California that is a Medi-Cal waiver or managed-care plan authorization, a Long-Term Care insurance authorization, a VA authorization, or a private-pay care plan. Personal care usually rides on HCPCS T1019, per 15 minutes, with whatever modifiers the payer requires.
The visit that actually happened. Since January 1, 2022, personal care services in California must be captured through electronic visit verification, and home health care since January 1, 2023. California runs a state EVV system called CalEVV, built on the Sandata platform, and also permits certified alternate, open-model EVV systems.
The claim you actually submitted. This is where delivered hours are supposed to become T1019 units on a claim, at the right rate and modifier.
The remittance. What the payer actually allowed and paid, after denials, adjustments, and edits.
The money does not leak in any one column. It leaks in the gaps between them.
- 01Delivered in EVV, never billed
- 02Sliding into the six-month filing penalty
- 03Authorization expiring with hours left
- 04Over-delivery above the authorized ceiling
- 05Unit or modifier mismatch on the claim
Every number here is illustrative and synthetic. It shows the method, not a result, and not a California rate. Reeve reports these as hours, units, and records to price against your own contracted rate sheet.
Illustrative: 47 visits appear as completed, verified visits in your EVV export across the last two quarters, with no matching claim line and no matching remittance. Total roughly 141 authorized units of T1019, in 15-minute increments. These are visits your caregivers worked and CalEVV recorded, that never became a claim. Records attached. Price them against your own rate.
Illustrative: 18 verified visits carry a service month now between seven and nine months back, payable at only 75 percent if billed today, and 6 more have crossed twelve months and can no longer be filed at all. Reeve does not dollarize the loss for you, because that depends on your rate. It hands you the 24 records and the exact service dates so you can decide what is still worth chasing before the clock moves again.
Illustrative: 9 active authorizations are set to lapse within 30 days with a combined 212 authorized-but-unused hours still on them. That is care you are entitled to deliver and bill, that will quietly expire unless a new authorization is opened. This is a scheduling and reauthorization gap, surfaced early enough to act on.
Illustrative: 5 clients show delivered hours running above their authorized ceiling, roughly 63 hours in total. Reeve flags these separately and does not count them as recoverable, because hours delivered beyond an authorization are not reimbursable. This is the honest half of the picture: knowing what you cannot bill protects you from quoting a number that will not collect.
Illustrative: 12 claim lines carry a unit count or modifier on T1019 that does not match the underlying authorization, the kind of mismatch that reads clean until a payer edit catches it. Reeve lists the 12 records and the specific field that disagrees, so your biller can reconcile before it becomes a denial or a recovery.
Why an annual audit or the EMR alone misses this.
The audit is too late for California's clock. A once-a-year review that lands in the spring is looking at visits that, for much of the prior year, are already past the six-month mark. By the time an annual audit flags an unbilled January visit, that visit is in the 50 percent tier or already denied. California's sliding penalty rewards catching the gap in weeks, not quarters. An annual cadence structurally cannot.
The EMR sees its own column, not the reconciliation. Your scheduling and EVV system knows what was delivered. Your billing system knows what was submitted. The remittance knows what was paid. No single one of them sits across all four columns at once and asks whether a verified CalEVV visit ever became a paid T1019 line.
The gap between systems is exactly where the money is, and it is exactly the seam no single system is built to watch. A verified visit that never became a paid claim throws no error inside any one of them, because each one only sees its own column.
A suite adds features inside each column. Reeve does one job across the seams between them.
Plain answers, on the record.
Straight answers about what the Margin Review does, what it does not do, and where your data goes.
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.
One pass over your own export, in your browser. The findings are yours to keep, with no obligation.
The recovery lane. Care you delivered and never billed, units short of what was authorized, lines paid under the published rate.
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.
Try it yourself. Run a free Margin Review.
Run the free, read-only Margin Review on your own export. It opens in your browser, replaces names with a coded reference locally, and shows you where your authorized, delivered, billed, and paid columns disagree, with the record behind every finding.
- 01
Read-only. Reeve reads your export. It does not write to your EMR, does not file a claim, does not move money.
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Names coded in your browser. Names and identifiers are replaced with a coded reference locally before any math runs.
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No client name, no address, no identifier ever crosses to Reeve.
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The finding is yours, whether or not we ever work together.
Every example figure here is illustrative and synthetic, method rather than results, and California findings are reported in hours, units, and records, never invented dollars.