Reeve
Run it free
Menu
ReeveFor Idaho home care agenciesRead only

Idaho home care margin recovery.

You delivered the visits. In Idaho, State Plan PCS is hard-capped at 16 hours per week per adult, EVV data has to land in Sandata, and the filing clock is 365 days. Reeve has read the Idaho Aged & Disabled (A&D) Waiver Services fee schedule, date effective 07/01/2026, off the state's published PDF, and holds it by code, modifier, unit and effective date. Reeve reads your own billing export, right in your browser, and shows you the authorized, delivered, billed, and paid columns side by side, so the gaps have a record attached.

Start my free Margin Review
The four numbers

Every dollar of personal care in Idaho passes through four states of being, and they do not always agree.

Authorized

The payer approved a number of units. In Idaho that is a State Plan Personal Care Services authorization, agency-directed, hard-capped at 16 hours per week for an adult, or an Aged & Disabled HCBS Waiver authorization for members at nursing-facility level of care. The clock and the ceiling both live here, and the weekly ceiling is where a lot of Idaho exposure hides.

Delivered

The aide worked the visit and it landed in Electronic Visit Verification. Idaho is open EVV, provider-choice, but the visit data has to route to the state aggregator Sandata, required since July 1, 2021. Either way, the visit becomes an accepted EVV transaction, or it does not.

Billed

A claim went out to Idaho Medicaid with a Medicaid ID, date of service, NPI, a HCPCS code, its modifiers, and a unit count. Personal care usually rides on T1019 per 15 minutes, with T1020 available as a per diem alternative. Units are counted in quarter hours, so small miscounts and quarter-hour rounding add up fast.

Paid

The claim matched, cleared its other edits, and remitted. Or it hit a mismatch and denied.

The leaks live in the gaps between those four columns, and Idaho has two rules that turn a gap into lost money: EVV data has to land in Sandata to support the claim, and units above the authorized weekly ceiling, or above the 16-hour State Plan cap, are non-reimbursable no matter how much care was delivered.

  • 01
    Delivered but never billed
  • 02
    EVV visit not present or not verified in Sandata at claim time
  • 03
    Billed fewer units than the visit shows
  • 04
    Hours above the 16-hour weekly PCS cap
  • 05
    Aged past the 365-day filing window
Illustrative findings

Every number is illustrative and synthetic. Reeve holds the Idaho A&D Waiver Services fee schedule effective 07/01/2026 by code, modifier and unit, and prices Idaho lines off it where the schedule prints a figure. That schedule's own face excludes Certified Family Home (CFH) A&D/PCS providers, Personal Assistance Agencies (PAA), and Residential Assisted Living Facilities (RALF), which have separate schedules, so Reeve will not price those provider types from this table. Rows the schedule itself prints as "As Authorized" or "Manual Price" carry no rate, and Reeve will not quote one. Where no verified rate applies, findings are expressed in hours, units, and records to check against your own rate sheet, never in dollars Reeve made up.

Finding A
T1019 unit mismatch, silent shortfall
14 claims paid clean this quarter where the accepted Sandata visit shows more delivered quarter-hour units than the claim billed. Example: a visit accepted for 13 units of T1019, claim billed 10. The claim matched and paid, so nothing flagged, but 3 units per visit across 14 visits is 42 units of delivered care that never turned into a claim line. Records attached, ready to check against your contracted rate.
Finding B
No visit found in Sandata, denied and not reworked
12 denied claim lines where the accepted EVV visit is missing or not verified in Sandata at claim time. Example: the visit fired from a proprietary system but never reconciled into Sandata. Ten of the twelve are still inside the appeal window and reworkable today. The other two are past it.
Finding C
State Plan 16-hour weekly cap versus delivery
4 adult clients where delivered and accepted EVV hours exceed the 16-hour weekly PCS ceiling. This is not recoverable, and Reeve will not pretend it is. It surfaces separately as over-delivery, care your aides gave that was never authorized under the State Plan, so you can see the exposure, move higher-need members onto the A&D waiver where appropriate, and fix the auth going forward rather than quote it as money owed.
Finding D
Timely-filing risk, the 365-day shelf
17 delivered-and-accepted EVV visits with no matching claim found in the export, sorted by date of service against the 365-day clock. 9 are still inside the window and billable now. 5 are between 365 and 540 days, appeal-or-lose territory depending on the reason. 3 are gone. The list is ranked by days remaining, so the billable ones are at the top.
Finding E
Attendant ID mismatch, Sandata versus claim
4 visits where the aide identifier on the accepted Sandata transaction does not line up with the provider identifier on the claim. Each one is a denial waiting to happen or one that already did, with the specific visit and claim record paired so your biller can see exactly which field to correct.
The blind spot

Why an annual audit or the EMR alone misses this.

01

A once-a-year audit looks back over twelve months. In Idaho the money has a 365-day clock and the weekly cap is not something you can rework after the fact. By the time an annual review names a denied line, the appeal window may be shut and the weekly-cap exposure has been quietly accumulating for months. An annual review names the denied line long after the window to rework it in Idaho has shut.

02

The EMR is not built to catch it either. Your EMR knows what it billed. Sandata knows what visit was accepted. The remittance knows what paid. Those three live in three places, and the mismatch is in the seam between them. A clean match shows green in your billing screen even when the visit carried more units than the claim, because the claim matched the units it declared, not the units delivered.

03

The gap only shows when you put the accepted Sandata transaction, the claim, and the remittance in the same view and read them together, week by week against the 16-hour cap. That is the one thing Reeve does. It reads across the seam.

That is what Reeve reads for in Idaho: what Sandata accepted, what the authorization allowed, what you billed, and what actually paid, read together rather than audited for rate.

Questions

Plain answers, on the record.

Straight answers on how the Idaho Margin Review works, what it touches, and what it will not claim.

01
Is Reeve going to tell me a dollar figure for what I can recover in Idaho?
Where it can cite one, yes. Reeve has read the Idaho A&D Waiver Services fee schedule, date effective 07/01/2026, off the state's published PDF and holds it by code, modifier, unit and effective date, so an Idaho line on a code that schedule prices is priced off the schedule and the citation travels with the finding. It is also a ceiling: if your own book carries a rate above the published max allowable, Reeve prices at the published figure and hands you the difference as a rate-sheet question rather than a bigger number. Where the schedule prints no rate, Reeve gives you the hours, the units, and the exact records instead of a dollar. A rate Reeve has not verified is a rate Reeve will not quote.
02
Does my data leave my building?
No. The Margin Review runs in your own browser on an export you provide. Client names, Medicaid IDs, and aide names are replaced with a coded reference locally before any math runs. Nothing with a name on it is uploaded or sent anywhere. Reeve reads. It does not write to your EMR, does not file a claim, and does not move money.
03
What Idaho rule is Reeve actually reconciling against?
Two: the Sandata EVV requirement in effect since July 1, 2021, and the State Plan PCS 16-hour weekly cap for adults. A claim without a matching, verified Sandata visit will not stand up, and hours above the weekly ceiling are non-reimbursable. Reeve lines up the visit, the claim, and the remittance and shows you where either rule was crossed.
04
Which Idaho programs and codes does this cover?
State Plan Personal Care Services, agency-directed, and the Aged & Disabled HCBS Waiver for members at nursing-facility level of care. Common codes are T1019 for 15-minute personal care and T1020 for a per diem alternative. The published schedule Reeve holds is the A&D Waiver Services fee schedule effective 07/01/2026, and it excludes CFH A&D/PCS providers, Personal Assistance Agencies, and Residential Assisted Living Facilities, which are priced on separate schedules Reeve does not hold and will not substitute for.
05
Is Idaho adult day billed per diem?
No. Idaho adult day health (S5100) and day habilitation (T2021) are billed per 15-minute unit in Idaho, not per diem, and Reeve prices them that way. The words diem, half-day and full-day do not appear on the schedule. Reeve reads the unit basis off the rate row rather than assuming it, because the same service is per diem in other states and guessing the basis is a four-fold error in whichever direction it guesses.
06
We use a proprietary EVV that transmits to Sandata. Do we need to switch?
No. Reeve reads the export your proprietary system and Sandata produce and reconciles them against your claims and remittances. It sits above your stack, read-only, and will surface any visit that failed to reconcile into Sandata regardless of which EVV vendor originated it.
07
How does the 16-hour weekly cap show up in the review?
As exposure, not recoverable. Reeve totals delivered and accepted EVV hours per adult member per week and flags every week that exceeds 16 hours on State Plan PCS. The point is to see the exposure and, where appropriate, move higher-need members onto the A&D waiver, not to quote over-cap hours as money owed.
08
Who runs the review, and is there a catch?
You do, yourself, for free. There is no sales call required to try it, no automated nightly scanning of your systems, and no team quietly holding your data. You provide an export, the review runs locally, and you keep the findings whether or not we ever work together.
Two lanes, priced separately

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

Try it yourself. Run a free Margin Review.

No sales call. No account to create. Export your data, open the review in your browser, and see your authorized, delivered, billed, and paid columns lined up in about the time it takes to read this page.

Start my free Margin Review
  • 01

    Read-only. Reeve reads your export and does not write to your EMR, does not file a claim, does not move money.

  • 02

    Names coded locally. Names and Medicaid IDs are replaced with a coded reference in your browser before any analysis runs.

  • 03

    Your file is processed in your browser, and no name is written into any output. No upload of identified data, no server holding your client list.

  • 04

    Yours to keep. The findings are yours whether or not we ever work together.

Reeve reads your billing read-only and replaces its names with coded references before any math runs. Every example figure is illustrative and synthetic, method rather than results, and Reeve makes no guarantee of recovery.