Kansas KanCare home care margin recovery.
You delivered the visits.
In Kansas, effective January 23, 2025 AuthentiCare is the sole claims-entry point for EVV-required services, and the KanCare plans are Healthy Blue Kansas, Sunflower Health Plan, and UnitedHealthcare Community Plan. Reeve has not verified a published filing window for any of the three against a primary source, so it does not state one. 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 personal care in Kansas passes through four states of being, and they do not always agree.
The payer approved a number of units. In Kansas that is KanCare, run since January 1, 2025 by Healthy Blue Kansas, Sunflower Health Plan, and UnitedHealthcare Community Plan, https://www.kancare.ks.gov/, after Aetna Better Health of Kansas left the program on December 31, 2024, with attendant hours authorized under HCBS waivers including Frail Elderly and Physical Disability, and self-directed delivery in some cases. The clock and the ceiling both live here, and each MCO sets its own filing window inside the state rule.
The people who deliver the care worked the visit and it landed in Electronic Visit Verification. Kansas is provider-choice on EVV, but the state EVV system is AuthentiCare, operated by Netsmart. Effective January 23, 2025, AuthentiCare is not just an aggregator, it is the sole claims-entry point for EVV-required services. Either way, the visit becomes an accepted AuthentiCare transaction, or it does not.
A claim went out through AuthentiCare to the correct KanCare MCO with a Medicaid ID, date of service, NPI, a HCPCS code, its waiver modifier, and a unit count. Attendant care predominantly rides on T1019 per 15 minutes, with waiver modifiers distinguishing FE from PD and agency from self-directed. Units are counted in quarter hours, so small miscounts add up fast.
The claim matched, cleared its other edits, and remitted from the MCO. Or it hit a mismatch and denied.
The leaks live in the gaps between those four columns, and Kansas has two rules that turn a gap into lost money: after January 23, 2025 an EVV-required claim that does not originate through AuthentiCare is denied on entry, and each MCO enforces its own filing window by contract inside the state rule. Reeve has not verified a published window for Healthy Blue Kansas, Sunflower, or UnitedHealthcare against a primary source, so it names the payer and the age of the line rather than stating a deadline it cannot source. What Kansas does publish is a floor on what those plans pay: the state provider page requires a KanCare plan to pay a contracted provider at least 100 percent of the current fee for service Medicaid rate, and 90 percent out of network, https://www.kancare.ks.gov/providers/become-a-provider. Reeve reads a KanCare line against that minimum, looks only below it, and treats a line paid at the prior fiscal year figure in the first weeks after July 1 as a timing question rather than an underpayment.
- 01Delivered but never billed
- 02Initial claim submitted outside AuthentiCare and denied on entry
- 03Billed fewer units than the visit shows
- 04Denied for a waiver-modifier or attendant-ID mismatch
- 05Aged past the tighter MCO 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.
15 claims paid clean this quarter where the accepted AuthentiCare visit shows more delivered quarter-hour units than the claim billed. Example: a visit accepted for 13 units of T1019, claim billed 9. The claim matched and paid, so nothing flagged, but 4 units per visit across 15 visits is 60 units of delivered care that never turned into a claim line. Records attached, ready to check against your contracted rate.
10 denied claim lines where the initial claim was submitted directly to the MCO rather than through AuthentiCare after January 23, 2025. The visits themselves are accepted in AuthentiCare, but the claim entry point is wrong. All 10 are workable today by resubmitting through AuthentiCare inside the MCO window. This is the single most avoidable Kansas denial.
3 clients where delivered and accepted EVV units exceed the authorized waiver units on file. 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.
20 delivered-and-accepted EVV visits with no matching claim found in the export, sorted by date of service and oldest first, with the plan named on each line. Kansas is one of the states where Reeve holds no verified filing window, so it ranks these by age against the plan rather than telling you which are gone. Read them against the window in your own contract with Healthy Blue Kansas, Sunflower, or UnitedHealthcare.
6 claim lines where the waiver modifier on the claim does not match the authorization, most commonly a Frail Elderly authorization billed with the Physical Disability modifier or vice versa. 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 Kansas each KanCare plan sets its filing window by contract, and Reeve has verified none of them. By the time an annual review names a denied line, the shortest of those windows has usually run. By the time an annual audit names a denied Kansas line, the window to rework it is usually gone.
The EMR is not built to catch it either. Your EMR knows what it billed. AuthentiCare knows what visit was accepted and whether the claim originated there. The MCO remittance knows what paid. Those three live in three places, and the mismatch is in the seam between them. After the January 23, 2025 change, the entry-point question alone is enough to deny a valid, authorized, delivered visit.
The gap only shows when you put the accepted AuthentiCare transaction, the claim entry point, the MCO remittance, and the MCO's filing clock in the same view and read them together. That is the one thing Reeve does. It reads across the seam.
That is what Reeve reads for in Kansas: what AuthentiCare 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 Kansas 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.