Nevada home-care margin recovery: two EVV transitions, and the claims that fell through both seams.

Nevada has handed its home-care agencies two system changes in the space of about two years, and each one created a stretch of claims that quietly never got paid. The first was the move from AuthentiCare to Sandata at the start of 2024, a cutover that, by contemporaneous reporting, left some personal-care agencies short-paid or unpaid for hours their caregivers had genuinely worked. The second was the April 2026 change to how EVV claims route to payers. Transitions like these are where margin disappears, because the failures are not about bad care. They are about claims falling through the seam between an old system and a new one, and getting written off as too messy to chase.

This page is about where margin actually leaks in Nevada, and why catching it means reading your Sandata data against the authorizations and the remittances rather than trusting that a delivered visit survived two system changes.

The 2024 switch left real visits unpaid

Nevada's Division of Health Care Financing and Policy moved its EVV system to Sandata Technologies effective January 1, 2024, replacing AuthentiCare. The state runs an open-choice model, so providers with their own systems can keep them, but the state's EVV system is now Sandata, and the visit has to reach it for the claim to pay.

The cutover did not land cleanly for everyone. Reporting from that period described personal-care agencies not being paid correctly for hours their caregivers worked, with the new system in some cases miscalculating or deleting claims. The care happened. The clock-ins happened. But the new system did not carry every claim across correctly, and agencies absorbed the loss.

Those transition-era claims are the most recoverable kind, and the most commonly abandoned. They are not denials anyone caused. They are the byproduct of a system change, and many of them are still correctable if someone goes back and reconciles what was delivered against what was actually paid.

The 2026 routing change opened a second seam

Per Nevada Medicaid guidance, as of April 1, 2026, EVV claims are no longer routed through Optum and are instead submitted directly to the respective payers. Providers on the Sandata sponsored tool have the routing changes handled for them. But any time the claims path changes, claims can fall into the gap between the old and new routing, and the weeks around that change are a prime window for misrouted or unmatched claims. It is also worth noting that agencies had to set up Sandata to submit their 837 EDI files and receive their 835 files through the Provider Web Portal, and an EDI setup issue there can silently block payment.

Where the margin actually leaks in Nevada

From Nevada's two recent transitions and its open-choice EVV model, the recoverable losses cluster in a few predictable places:

• 2024 transition losses. Visits short-paid or unpaid during the AuthentiCare-to-Sandata cutover, where the new system miscalculated or dropped claims. The most Nevada-specific recoverable bucket.
• 2026 routing-change losses. Claims caught in the seam when EVV claims stopped routing through Optum and moved to direct-to-payer submission.
• Sandata sync gaps. Visits that did not reach Sandata cleanly, or reached it with a data element that does not match the claim.
• EDI setup issues. 837 and 835 routing through the Provider Web Portal that was misconfigured, silently blocking payment.
• Silent underpayments. Claims that pay below the authorized amount. They never show up as a denial, only when payment received is compared to payment expected, line by line.

None of these are visible from 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 authorization, the routing, 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 Nevada agency, that means lining up the Sandata visit data, the claim lines, the authorizations, and the remittances, then surfacing every place they fail to reconcile: the 2024 transition losses, the 2026 routing-change losses, the sync gaps, 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 system transition or an EDI setup. You get a ranked list of recoverable dollars with the reason attached: the transition-era claim never reworked, the misrouted claim, the underpaid line. The ones still inside the filing window are the ones you can rebill now, and in a state with two recent transitions, that bucket is often larger than agencies expect.

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 claim-denial mechanics, see home-care claim denials and recovery. And for the broader map of revenue loss, see where home-care margin leaks.

What the free Nevada Margin Teardown does

The way to find out whether the 2024 switch and the 2026 routing change left money on the table 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 in your book: the transition-era unpaid and short-paid claims, the routing-change losses, the Sandata sync gaps, 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.