Missouri home-care margin recovery: your EVV system has to feed Sandata, and the care plan lives somewhere else.

Missouri's setup is deceptively split. You choose your own EVV software, which feels like control. But that choice puts the burden of clean data exchange on your system, because everything has to reach the state's Sandata aggregator to count. And the units you are allowed to bill do not live in your EVV system or even in the aggregator. They live in the HCBS Web Tool the Department of Health and Senior Services runs. So a delivered visit in Missouri has to survive two separate reconciliations: it has to land at Sandata cleanly, and it has to match a care plan held in a different state system. On a personal-care book, the space between those two is where margin quietly disappears.

This page is about where money leaks in Missouri specifically, and why catching it means reading your data against the aggregator and the care plan together, not trusting that a scheduled visit became a paid claim.

Open vendor puts the exchange on you

Missouri chose an open-vendor model. The MO HealthNet Division lets personal-care and home-health providers run any EVV vendor that fits, or keep an existing one, as long as it is compatible with the state's aggregation specifications. That is real flexibility. It also quietly shifts a responsibility onto your shoulders.

Because all EVV data has to flow to the EVV Aggregator Solution, the state's Sandata-hosted store, your chosen system is the one that has to exchange every visit cleanly. Effective November 8, 2021, that exchange became mandatory, and every PCS provider with authorized participants has to register its EVV vendor with the aggregator. When your system's feed hiccups, a real visit can simply never arrive at Sandata in a usable state, and the state has no record to pay against.

The care plan lives in a different system than the visit

Here is the structural quirk that makes Missouri distinctive. The approved services and units are not stored with the visit. They live in the HCBS Web Tool, run by the Department of Health and Senior Services, where care plans are submitted and managed. The visit record sits at Sandata. The authorization sits in the web tool. The claim has to reconcile to both.

That separation is where the money goes. A care plan gets revised in the web tool, the agency keeps billing the old unit count, and the claims drift outside the authorization without anyone seeing it, because the schedule and the EVV app both still say the visit happened. In the Consumer Directed Services model, where the participant manages the attendant, that drift is even easier to miss.

Where the margin actually leaks in Missouri

From the way Missouri pairs an open-vendor aggregator with a separate care-plan system, the recoverable losses cluster in a few predictable places:

• Aggregator exchange gaps. Visits captured in your own EVV system that did not exchange cleanly into the Sandata aggregator, or arrived with a data element that does not match the claim. The most open-vendor-specific leak.
• Care-plan unit mismatches. Billed units that do not reconcile to the units approved on the HCBS Web Tool care plan, especially after a plan revision.
• CDS plan drift. Consumer Directed Services claims that fall outside the participant's authorized plan, where the participant-managed structure makes the lapse harder to catch.
• Registration and feed lapses. Periods where an EVV vendor change or a registration gap broke the exchange, leaving a stretch of unmatched claims.
• Silent underpayments. Claims that pay below the authorized amount. They never surface as a denial, only when payment received is compared to payment expected, line by line.

None of these show up in the scheduling view. The schedule says the visit happened. Your EVV app says the caregiver clocked in. The gap appears only when you reconcile the Sandata record, the HCBS Web Tool care plan, and the actual remittance against the claim line.

Why a read-only recovery layer is the right tool for this

Reeve is built for exactly this reconciliation. It sits read-only over whatever EMR and EVV export an agency already runs, whether that is WellSky, AxisCare, HHAeXchange, AlayaCare, or anything else, and compares what was delivered against what was authorized against what was actually paid. For a Missouri agency, that means lining up the visit data sent to Sandata, the claim lines, and the HCBS Web Tool care plans, then surfacing every place they fail to reconcile: the exchange gaps, the care-plan unit mismatches, the CDS drift, and the silent underpayments.

Reeve is read-only and neutral across every EMR, so it has no stake in which system you run, and it never writes to your billing workflow without your control. It does not sell scheduling or EVV, so it has no reason to look past a finding that points at a billing module or at your chosen EVV vendor's feed. You get a ranked list of recoverable dollars with the reason attached: the visit that never reached Sandata, the unit count that outran the care plan, the underpaid line. The ones still inside the filing window are the ones you can rebill now.

This is the same engine described across the rest of the site. For the mechanics of how EVV gaps become denials, see EVV billing for home care. For the authorization side specifically, see home-care authorization tracking. And for the broader map of revenue loss, see where home-care margin leaks.

What the free Missouri Margin Teardown does

The way to find out whether the Sandata exchange and the HCBS Web Tool care plan are drifting apart on your book is to look at a real, de-identified slice of your own data before you spend a dollar. The Margin Teardown is a one-time, read-only read of where margin is leaking: the visits that never reached the aggregator, the care-plan unit mismatches, the CDS drift, and the underpayments. It is free, and it is yours to keep whether or not you ever work with Reeve. It carries the same 3×-or-free guarantee the rest of the engine does. If Reeve does not surface at least three times its monthly fee in recoverable margin you agree is real, you do not pay.