Nevada home care margin recovery.
You delivered the visits. In Nevada, PCS needs a Form FA-24 prior authorization, EVV runs through Sandata, and the in-state 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 personal care in Nevada passes through four states of being, and they do not always agree.
The payer approved a number of units. In Nevada that is a Medicaid State Plan Personal Care Services authorization on Form FA-24, delivered by Provider Type 30, with Provider Type 83 covering the intermediary service organization and self-directed skilled model. The clock and the ceiling both live here.
The aide worked the visit and it landed in Electronic Visit Verification. Nevada runs an Open Choice EVV model, but the state EVV system is Sandata, and the visit still has to reach Sandata to support the claim. The visit becomes an accepted Sandata transaction, or it does not.
A claim went out to Nevada Medicaid with a Medicaid ID, date of service, NPI, a HCPCS code, and a unit count. Personal care rides on T1019 with one unit equal to 15 minutes, and the self-directed skilled variant carries the TF modifier as T1019-TF. 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 mismatch and denied.
The leaks live in the gaps between those four columns, and Nevada has two rules that turn a gap into lost money: PCS requires an FA-24 prior authorization and a matching accepted Sandata visit for the claim to pay, and the in-state filing clock is only 180 days from date of service, with 365 days only when there is other coverage or the provider is out of state.
- 01Delivered but never billed
- 02Sandata visit missing or unreconciled at claim time
- 03Delivered outside the FA-24 authorization
- 04T1019-TF billed without the self-directed skilled modifier, or vice versa
- 05Aged past the 180-day in-state 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.
Why an annual audit or the EMR alone misses this.
A once-a-year audit looks back over twelve months. In Nevada the money has a 180-day in-state clock. By the time an annual review names a denied line, the primary filing window is long shut and the fallback 365-day window only applies if there is other coverage or the provider is out of state. An audit describes the hole. It does not hand it back to you while the clock is still open.
The EMR is not built to catch it either. Your EMR knows what it billed and which provider type is billing. Sandata knows what visit was accepted. The remittance knows what paid. Those three live in three places, and the mismatch is in the seam between them. A clean match shows green in your billing screen even when the visit carried more units than the claim, or when the TF modifier disagreed with the provider type.
The gap only shows when you put the accepted Sandata transaction, the FA-24 authorization, the claim with its modifier and provider type, and the remittance 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 Nevada: what Sandata accepted, what the authorization allowed, what you billed, and what actually paid, read together rather than audited for rate.
Plain answers, on the record.
Straight answers on how the Nevada Margin Review works, what it touches, and what it will not claim.
- 01Is Reeve going to tell me a dollar figure for what I can recover in Nevada?
- No made up numbers. Reeve prices findings off the rate on your own export or the rate your own remittances actually paid most often, and where it cannot find a rate in your data it gives you the hours, the units, and the exact records instead of a dollar figure. A rate Reeve has not verified is a rate Reeve will not quote.
- 02Does my data leave my building?
- No. The Margin Review runs in your own browser on an export you provide. Client names, Medicaid IDs, and aide names are replaced with a coded reference locally before any math runs. Nothing with a name on it is uploaded or sent anywhere. Reeve reads. It does not write to your EMR, does not file a claim, and does not move money.
- 03What Nevada rule is Reeve actually reconciling against?
- Two: the FA-24 prior authorization requirement for PCS and the Sandata EVV match, plus the 180-day in-state filing clock. A claim without an FA-24-backed, Sandata-matched visit does not pay, and a claim filed after 180 days in-state is generally gone unless there is other coverage or the provider is out of state. Reeve lines up the FA-24, the visit, the claim, and the remittance and shows you where any of those disagree.
- 04Which Nevada programs and codes does this cover?
- Medicaid State Plan Personal Care Services under Provider Type 30 and the intermediary service organization and self-directed skilled model under Provider Type 83. Common code is T1019 with one unit equal to 15 minutes, and T1019-TF for the self-directed skilled variant.
- 05We use another EVV vendor under Open Choice. Do we have to switch to Sandata?
- No. Open Choice allows the vendor of your choice, but the visit still has to reach the state Sandata record to support the claim. Reeve reads the export your vendor and Sandata produce and flags any visit that failed to reconcile, so you can fix it before the 180-day window closes.
- 06How does the 180 versus 365-day rule show up in the review?
- Reeve sorts findings by the operative clock per line. In-state lines get 180 days. Lines with other coverage or an out-of-state provider get 365. Delivered visits inside the window are billable now and go to the top. Everything else is ranked by days remaining or marked gone, clearly separated.
- 07Who runs the review, and is there a catch?
- You do, yourself, for free. There is no sales call required to try it, no automated nightly scanning of your systems, and no team quietly holding your data. You provide an export, the review runs locally, and you keep the findings whether or not we ever work together.
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.
- 01
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 Medicaid IDs are replaced with a coded reference in your browser before any analysis runs.
- 03
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.