Indiana home care margin recovery.
You delivered the visits. In Indiana, PathWays for Aging launched July 1, 2024, HCBS claims without a matching Sandata EVV record auto-deny with no grace period, and the fee-for-service filing clock is only 180 days. 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.
Every dollar of attendant care in Indiana passes through four states of being, and they do not always agree.
The payer approved a number of units. In Indiana that is a PathWays for Aging authorization for members 60 and over under the managed long-term services program that launched July 1, 2024, or a Health and Wellness waiver authorization for members under 60. The service line is Attendant Care. The clock and the ceiling both live here.
The attendant worked the visit and it landed in Electronic Visit Verification. Indiana runs an open EVV model with Sandata as the state aggregator. The visit becomes an accepted Sandata transaction, or it does not, and PathWays HCBS claims will not pay without a matching Sandata record.
A claim went out to the correct payer, whether IHCP fee-for-service or a PathWays MCE, with a Medicaid ID, date of service, NPI, S5125 per 15 minutes for attendant care, its agency-versus-non-agency modifier, and a unit count. S5130 covers homemaker. Units are counted in quarter hours, so small miscounts add up fast.
The claim matched, cleared its other edits, and remitted. Or it hit a Sandata mismatch or a filing-clock issue and denied.
The leaks live in the gaps between those four columns, and Indiana has two rules that turn a gap into lost money: under PathWays, HCBS claims without a matching accepted Sandata EVV record are auto-denied on hard edits with no grace period, and the IHCP fee-for-service filing clock is only 180 days from date of service, with MCE windows that may differ.
- 01Delivered but never billed
- 02Sandata visit missing or unreconciled at claim time
- 03Agency versus non-agency modifier mismatch on S5125
- 04S5125 billed where S5130 was correct, or vice versa
- 05Aged past the 180-day IHCP filing window
Every number is illustrative and synthetic. Because your own export may not carry a rate for every code, findings on this page are expressed in hours, units, and records to check against your own rate sheet, never in dollars Reeve made up.
Why an annual audit or the EMR alone misses this.
A once-a-year audit looks back over twelve months. In Indiana the IHCP money has a 180-day clock and PathWays HCBS claims auto-deny on the Sandata hard edit with no grace period. By the time an annual review names a denied line, the fee-for-service window is long shut and the PathWays MCE window is close behind. An annual audit is a record of what already went. It is not a worklist you can still act on.
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 or auto-denied. Those three live in three places, and the mismatch is in the seam between them. A clean-looking billing screen does not tell you that the visit never reconciled to Sandata until the claim comes back denied.
The gap only shows when you put the accepted Sandata transaction, the authorization with its modifier, the claim, and the remittance in the same view and read them together against the operative filing clock. That is the one thing Reeve does. It reads across the seam.
That is what Reeve reads for in Indiana: what Sandata accepted, what the authorization allowed, what you billed, and what actually paid, read against each other rather than audited for rate.
Plain answers, on the record.
Straight answers on how the Indiana Margin Review works, what it touches, and what it will not claim.
- 01Is Reeve going to tell me a dollar figure for what I can recover in Indiana?
- No made up numbers. Reeve prices findings off the rate on your own export or the rate your own remittances actually paid most often, and where it cannot find a rate in your data it gives you the hours, the units, and the exact records instead of a dollar figure. A rate Reeve has not verified is a rate Reeve will not quote.
- 02Does my data leave my building?
- No. The Margin Review runs in your own browser on an export you provide. Client names, Medicaid IDs, and attendant 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.
- 03What Indiana rules is Reeve actually reconciling against?
- Two: the PathWays HCBS Sandata hard edit that auto-denies claims without a matching accepted EVV record, and the IHCP fee-for-service 180-day filing clock, with MCE windows that may differ. Reeve lines up the Sandata record, the authorization, the claim, and the remittance and shows you where any of those disagree, per payer.
- 04Which Indiana programs and codes does this cover?
- PathWays for Aging for members 60 and over, the managed long-term services program that launched July 1, 2024, and the Health and Wellness waiver for members under 60. Attendant Care bills on S5125 per 15 minutes with agency and non-agency modifiers, and S5130 covers homemaker.
- 05We use another EVV vendor under the open model. Do we have to switch to Sandata?
- No. Reeve reads the export your vendor and Sandata produce and reconciles them against your claims and remittances. It sits above your stack, read-only, and specifically flags any PathWays HCBS visit that failed to reach Sandata, since that is the exact edit that will auto-deny the claim.
- 06How does the 180-day IHCP window versus MCE windows show up in the review?
- Reeve sorts findings by the operative clock per line. IHCP fee-for-service lines get 180 days. PathWays MCE lines are ranked against the MCE window. Delivered visits inside the window are billable now and go to the top. Everything else is ranked by days remaining or marked gone, per payer, clearly separated.
- 07Who 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.
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.
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.
- 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.