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 people who deliver the care 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.
13 attendant care 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 12 units of S5125, claim billed 10. The claim matched and paid, so nothing flagged, but 2 units per visit across 13 visits is 26 units of delivered care that never turned into a claim line. Records attached, ready to check against your contracted rate.
10 denied PathWays HCBS claim lines where the underlying visit is in your EVV vendor but did not reconcile to Sandata at claim time, so the hard edit auto-denied with no grace period. All 10 are workable today by reconciling the Sandata record and resubmitting inside the operative window.
3 members where delivered and accepted Sandata units exceed the authorized attendant care units on file under PathWays or the Health and Wellness waiver. This is not recoverable, and Reeve will not pretend it is. It surfaces separately as over-delivery, care the people who deliver it gave that was never authorized, so you can see the exposure and fix the auth going forward rather than quote it as money owed.
21 delivered-and-accepted Sandata visits with no matching claim found in the export, sorted by date of service against the operative clock. 11 are on IHCP fee-for-service inside the 180-day window and billable now. 6 are on a PathWays MCE and ranked against the MCE window. 4 are past every operative window and gone. The list is ranked by days remaining.
6 S5125 claim lines where the agency or non-agency modifier on the claim does not line up with the delivery model on the authorization, changing which rate applies. 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.
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.
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.
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Read-only. Reeve reads your export and does not write to your EMR, does not file a claim, does not move money.
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Names coded locally. Names and member identifiers are replaced with a coded reference in your browser before any analysis runs.
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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.
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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.