See your own book, before there is a fee.

Reeve reads what the record says, against what the claim carried, against what the remittance paid. In an hourly program that means authorized units against delivered units against billed units. Where your export names a payer, it classifies every row by payer before a single check runs. Where it does not, the coverage panel says so and no check could set a line aside for its payer. Reeve prices Medicaid fee for service, Medicaid managed care and private pay rows, where it holds rules. Medicare fee for service rows are priced from the published CMS tables on the home health and hospice books, and from nothing else. VA Community Care and Medicare Advantage long term services and supports rows are read for exposure only, at zero dollars, and never reach the recoverable total. Long term care insurance, Medicare Advantage on unclassified codes, Medicare Advantage paid by the episode, commercial insurance and another institutional payer rows are counted, named on the report, and excluded. Reeve prices adaptive behavior services where the state prints a code, a unit and a dollar on the page: IHCP applied behavior analysis therapy services in IN, Montana Medicaid applied behavior analysis in MT, Health First Colorado Pediatric Behavioral Therapy in CO. The Georgia DCH ASD fee schedule was read and prints no effective date, so those rows are held and refuse by name. In the 18 other states Reeve prices, the adaptive behavior schedule has not been read yet. Each one is recorded by name with the document the state publishes and the day that was last checked, and none of them prices. Medicare Advantage carries one narrow exception. Where the codes on the row are billed by the unit, one check runs on it, care delivered past what the plan authorized, and it comes back in units and never in dollars, because no Medicare Advantage rate is published anywhere we can cite. Every other check sets those rows aside and counts them. Anything paid as an episode or a per diem rather than a unit, outside the Medicare tables above, is excluded for the same reason: there is no conversion from a day into an authorized unit that Reeve can defend. Every check runs on this book. All 20 of them, with the 6 that can carry a dollar priced where the rate and the filing window are read from a primary source.