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 people who deliver the care 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.
7 PCS claims paid clean this quarter where the accepted Sandata visit shows more delivered quarter-hour units than the claim billed. Example: a visit accepted for 14 units of T1019, claim billed 10. The claim matched and paid, so nothing flagged, but 4 units per visit across 7 visits is 28 units of delivered care that never turned into a claim line. Records attached, ready to check against your contracted rate.
9 claim lines under Provider Type 83 where the self-directed skilled variant was billed as T1019 without the TF modifier, or as T1019-TF when the authorization was standard PCS under Provider Type 30. Six of the nine are still workable today. The other three are past the clock.
3 clients where delivered and accepted Sandata units exceed the authorized units on the FA-24 on file. This is not recoverable, and Reeve will not pretend it is. It surfaces separately as over-delivery, care your aides gave that was never authorized on the FA-24, so you can see the exposure and refresh the FA-24 going forward rather than quote it as money owed.
19 delivered-and-accepted Sandata visits with no matching claim found in the export, sorted by date of service against the operative filing clock. 11 are in-state and still inside the 180-day window and billable now. 5 are between 180 and 365 days, workable only if there is other coverage or the provider is out of state. 3 are past 365 and gone. The list is ranked by days remaining.
5 visits where the aide worked the visit in your vendor system but the Sandata record is missing, incomplete, or not accepted at the time the claim was submitted. 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 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.
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.