Does New York deny Medicaid home care claims when the EVV record does not match?

Not at initial adjudication today. New York's own EVV technical guidance states the EVV record is not matched to the claim during initial claim processing. The 2024 State Comptroller audit found most paid personal care and home health claims had no matching EVV record on file. That is exactly why the gap goes unnoticed and why reconciling EVV against paid claims now protects you from later takebacks.

What is New York's timely-filing window for Medicaid claims?

90 days from the date of service. Claims past 90 days need one of the recognized delay-reason codes to be accepted, and all claims must be finally submitted and payable within two years of the date of service, after which they are not payable.

Who is New York's EVV aggregator?

New York uses a Choice Model, so you select your own EVV vendor, but all Medicaid visit data must be submitted to the New York State EVV Data Aggregator, which the state operates through eMedNY and the Medicaid Management Information System.

Which New York home care services require EVV?

Personal care services, with a compliance date of January 1, 2021, and home health care services, with a compliance date of January 1, 2023. This covers personal care, CDPAP through fiscal intermediaries, state plan home health, and applicable 1915(c) waiver services.

Does Reeve tell me a dollar figure for New York?

No, and here is why plainly. Reeve never invents a rate. Dollars come from the rate on your own export or the rate your own remittances actually paid most often. Where Reeve cannot find a rate in your data, the finding still comes to you in hours, units, and the exact New York records where the four columns disagree, with the dollar figure left to your own rate sheet. A rate Reeve has not verified is a rate Reeve will not quote.

Does Reeve send anything to eMedNY or touch my claims?

No. Reeve reads. It does not write, does not file or adjusts a claim, and does not move money. It shows you where the gaps are and hands you the record. Any correction or rebill is done by you and your biller.

What does Reeve actually look at, and does patient data leave my building?

You provide a standard export from your EMR or EVV system. The Margin Review runs in your own browser, replaces names with a coded reference locally, and reconciles the four columns. Nothing with a member name, address, or Medicaid number leaves your building.

New York home care margin recovery: find the hours you delivered but never billed clean.

You are already delivering the care. In New York, the money leaks in the gap between what the plan authorized, what your aides delivered, what you billed to eMedNY, and what actually got paid. Reeve is a free, read-only Margin Review that lines those four columns up side by side and shows you every place they disagree, with the record attached.

Start my free Margin Review

The four numbers

New York home care runs on four numbers that are supposed to agree and quietly do not.

Authorized

Most New York personal care and home health hours are authorized by a Managed Long Term Care plan, a mainstream Medicaid Managed Care plan, or through a fiscal intermediary under CDPAP. The authorization is a ceiling: a number of hours or units per member, per week, under a specific service and rate code. Personal care rides on codes like T1019 billed in 15-minute units and T1020 per diem.

Delivered

Your aides show up and the visit gets captured through Electronic Visit Verification. New York runs a Choice Model, so you pick your own EVV vendor, but every Medicaid visit has to flow to the New York State EVV Data Aggregator operated through eMedNY. Six data elements have to land: the date, the start and end time, the service type, the caregiver, the member, and the location.

Billed

You submit the claim to eMedNY. New York holds you to a 90-day timely-filing window from the date of service. Miss it and you need one of the recognized delay-reason codes to get the claim in, and even those run out at the two-year outer limit, after which the claim is not payable at all.

Paid

The plan or eMedNY adjudicates and remits. But eMedNY does not currently match the EVV record to the claim at initial adjudication, so your EVV data and your paid claims drift apart with nothing forcing them back together.

The money does not leak in any one column. It leaks in the gaps between them, and in New York that gap cuts both ways: delivered visits captured in EVV that never turned into a clean paid claim, and paid claims with no matching EVV record that are clawback exposure waiting to happen.

01
Delivered and verified in EVV, but no matching claim in eMedNY remittance.
02
Paid claims with no matching EVV record on file, exactly what the state is auditing today.
03
Delivered hours billed below the authorized ceiling.
04
Visits continuing past an expired authorization end date.
05
Delivered visits aging toward the 90-day timely-filing wall.

Illustrative findings

Every number is illustrative and synthetic, built to show the method, not results from any real agency. 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.

Finding A

Delivered and verified, never billed

42 personal care visits over one closed month have a complete EVV record in your system but no matching T1019 claim line in eMedNY remittance. Roughly 118 units, 29.5 hours, sitting delivered and unbilled. 31 of the 42 are still inside the 90-day window and billable today. 11 have aged past 90 days and would need a valid delay-reason code or are lost.

Finding B

Billed below the authorization

On 14 members, delivered and EVV-verified hours came in under the plan authorization, and billed units came in under delivered. Example member: authorized 25 hours per week, delivered 25, billed 22. That is 3 hours per week across 14 members. Records attached so you can check each against your contracted rate.

Finding C

Paid claim with no EVV match, clawback exposure

67 paid personal care claim lines have no corresponding record in your EVV export for the same member, date, and service window. Under today's rules eMedNY paid them anyway. Each one is a repayment risk if the state matches EVV to the claim retroactively. Flagged to verify or correct now, not to bill.

Finding D

Authorization lapse mid-service

On 9 members, EVV shows visits continuing 6 to 19 days after the plan authorization end date, with no renewal on file. Delivered hours past an expired auth do not pay clean and invite denial or takeback. Reeve lists the member, the last authorized date, and the count of post-lapse verified visits.

Finding E

Timely-filing cliff

23 delivered, EVV-verified visits are between day 76 and day 89 from date of service and not yet billed. Inside the 90-day window today. Reeve ranks them by days remaining so the ones about to age out get worked first.

The blind spot

Why an annual audit or the EMR alone misses this in New York.

Your EMR is very good at running one visit forward: schedule it, verify it, drop the claim. It is not built to look backward across authorized, delivered, billed, and paid at the same time and tell you where those four columns stopped agreeing. It shows you the claim it sent. It does not reconcile that claim against the EVV record that should support it, because eMedNY does not force that match either.

That is the trap. Because New York pays many claims without matching EVV at adjudication, nothing in the normal flow ever tells you a delivered visit fell out or a paid claim is unsupported. It looks fine until an auditor pulls the thread.

And the clock is unforgiving. The 90-day filing window means a delivered visit you have not billed is not a someday problem, it is a this-quarter problem. An annual audit runs long after those visits crossed day 90 and became unrecoverable. The reconciliation has to happen on a closed period, monthly, while the window is still open. That is the job Reeve does.

A yearly look tells you what happened. Reeve shows you what is still recoverable, before an auditor does.

Questions

Plain answers, on the record.

Straight answers about how the Margin Review works in New York, what it touches, and what it will not claim.

01 Does New York deny Medicaid home care claims when the EVV record does not match?: Not at initial adjudication today. New York's own EVV technical guidance states the EVV record is not matched to the claim during initial claim processing. The 2024 State Comptroller audit found most paid personal care and home health claims had no matching EVV record on file. That is exactly why the gap goes unnoticed and why reconciling EVV against paid claims now protects you from later takebacks.
02 What is New York's timely-filing window for Medicaid claims?: 90 days from the date of service. Claims past 90 days need one of the recognized delay-reason codes to be accepted, and all claims must be finally submitted and payable within two years of the date of service, after which they are not payable.
03 Who is New York's EVV aggregator?: New York uses a Choice Model, so you select your own EVV vendor, but all Medicaid visit data must be submitted to the New York State EVV Data Aggregator, which the state operates through eMedNY and the Medicaid Management Information System.
04 Which New York home care services require EVV?: Personal care services, with a compliance date of January 1, 2021, and home health care services, with a compliance date of January 1, 2023. This covers personal care, CDPAP through fiscal intermediaries, state plan home health, and applicable 1915(c) waiver services.
05 Does Reeve tell me a dollar figure for New York?: No, and here is why plainly. Reeve never invents a rate. Dollars come from the rate on your own export or the rate your own remittances actually paid most often. Where Reeve cannot find a rate in your data, the finding still comes to you in hours, units, and the exact New York records where the four columns disagree, with the dollar figure left to your own rate sheet. A rate Reeve has not verified is a rate Reeve will not quote.
06 Does Reeve send anything to eMedNY or touch my claims?: No. Reeve reads. It does not write, does not file or adjusts a claim, and does not move money. It shows you where the gaps are and hands you the record. Any correction or rebill is done by you and your biller.
07 What does Reeve actually look at, and does patient data leave my building?: You provide a standard export from your EMR or EVV system. The Margin Review runs in your own browser, replaces names with a coded reference locally, and reconciles the four columns. Nothing with a member name, address, or Medicaid number leaves your building.

Two lanes, priced separately

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.

Margin Review

Free

One pass over your own export, in your browser. The findings are yours to keep, with no obligation.

Collect

$750 per branch per month

The recovery lane. Care you delivered and never billed, units short of what was authorized, lines paid under the published rate.

Cover

$1,000 per branch per month

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.

Start with a Margin Review

Try it yourself. Run a free Margin Review.

Run a free Margin Review on one closed month. You export the file, it opens in your browser, and you see every place your authorized, delivered, billed, and paid numbers stopped agreeing, with the record attached. No sales call required to see the finding.

Start my free Margin Review

01
Read-only. Reeve reads your data. It does not write to your EMR, does not file or change a claim, does not move a dollar.
02
Names coded on your machine. The review runs in your own browser and strips names, addresses, and Medicaid numbers locally, before any analysis.
03
Your file is processed in your browser, and no name is written into any output. No client-identified record is uploaded anywhere. You keep your data. You keep the finding, whether or not we ever work together.
04
No testimonials and no automated overnight scanning. It is a tool you run yourself on data you already have.

Any dollar figures in examples are illustrative and synthetic, method rather than results. Reeve never invents a rate; dollars come from the rate on your own export or the rate your own remittances actually paid most often.