EVV-to-billing reconciliation for Colorado home care agencies.
In Colorado the money lines up in three places, the authorization, the EVV record, and the claim. A Colorado claim without a matching EVV record denies.
The three-way match
The authorization sets the ceiling. Units, dates, codes, and rate. It is the maximum recoverable position for the period.
The Sandata EVV record proves delivery. Under the state's EVV framework, the visit is not verified without the aggregator-accepted record.
The claim and the remittance record what was billed and what was paid. Reconciliation means reading all three together, not any two.
The four failure modes
An EVV visit with no claim. Care delivered, verified, and never billed. Unbilled revenue.
A claim with no matching EVV, which Colorado denies with EOB code 3054, EVV record required and not found.
A claim and an EVV record that disagree on time, units, or service code. The visit is verified but the claim does not match the record.
A claim and an EVV record that agree but run past what the authorization covers. This is a real risk when a member has dual service types that draw down one authorization, and the overage is compliance exposure, not recoverable revenue.
What to pull
The Sandata EVV export, the EMR authorization detail, the billing claim register, and the remittance for a full closed month. Join them on member, date of service, and service code. Without all four, one of the four failure modes will be invisible.
A note on timing
Colorado adjusted personal-care rates effective July 1, 2026. A prior-year rate applied to a current period will overstate a figure. Anchor every calculation to the rate in effect for the date of service, not to the current fee schedule.
The bottom line
An unbilled visit is an asset until the timely filing deadline passes, and a write-off one second later. The three-way match, run monthly, is what keeps assets from turning into write-offs on the calendar rather than on the merits.
Plain answers, on the record.
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.
Run the three-way match on one closed month.
The Margin Review reconciles authorization, Sandata EVV, and claims for one closed period and returns a ranked list of recoverable dollars with a reason on each line.