Is Reeve going to tell me a dollar figure for what I can recover in North Carolina?

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.

Does 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.

What North Carolina rule is Reeve actually reconciling against?

The EVV claim-to-visit hard match and the authorization ceiling under Clinical Coverage Policy 3L. A PCS claim that does not line up with an accepted EVV visit on service code, modifiers, and units, or that exceeds the authorized amount, denies with no matching data. Reeve lines up the visit, the claim, and the remittance and shows you which field disagrees.

Which North Carolina programs and codes does this cover?

State Plan Personal Care Services under Clinical Coverage Policy 3L for in-home and 3L-1 for congregate, plus CAP/DA, CAP/C, and Innovations waiver attendant hours. In-home PCS bills on 99509 with HA or HB in 15-minute units. Congregate PCS uses HC, TT, SC, or HH and shifted to a per diem effective April 1, 2025.

We route EVV to Sandata, CareBridge, and HHAeXchange depending on the payer. Do we need to consolidate?

No. Reeve reads the exports those aggregators produce and reconciles each one against the claims and remittances for its payer. NC Medicaid Direct through Sandata, Healthy Blue through CareBridge, Standard and Tailored Plans and LME-MCOs through HHAeXchange. It sits above your stack, read-only.

How does the FFS 365 versus managed care 180 filing rule show up in the review?

Reeve sorts findings by the operative clock for each payer. FFS lines get 365 days. Managed care and secondary and crossover lines get 180. 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.

Who 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.

North Carolina home care margin recovery.

You delivered the visits. In North Carolina, a PCS claim that does not match the EVV visit and the authorization denies with no matching data, and the filing clock is 365 days on FFS but 180 days on managed care. 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.

Start my free Margin Review

The four numbers

Every dollar of personal care in North Carolina passes through four states of being, and they do not always agree.

Authorized

The payer approved a number of units or per diems. In North Carolina that is a PCS authorization under Clinical Coverage Policy 3L for in-home care or 3L-1 for congregate, or a waiver auth under CAP/DA, CAP/C, or Innovations. NC Medicaid Direct handles fee-for-service. Standard Plans, Tailored Plans, and LME-MCOs handle the rest. The clock and the ceiling both live here.

Delivered

The aide worked the visit and it landed in Electronic Visit Verification. North Carolina is open EVV, but the visit data still has to route to the correct aggregator: Sandata for NC Medicaid Direct FFS, CareBridge for Healthy Blue, HHAeXchange for the Standard and Tailored Plans and the LME-MCOs. Either way, the visit becomes an accepted EVV transaction, or it does not.

Billed

A claim went out to NCTracks or the health plan with a Medicaid ID, date of service, NPI, a HCPCS code, its modifiers, and a unit count. In-home PCS rides on 99509 with HA or HB, historically in 15-minute units. Congregate PCS uses HC, TT, SC, or HH and moved to a per diem rate effective April 1, 2025. Small miscounts on the 15-minute lines and per-diem-versus-unit confusion on the congregate lines both add up fast.

Paid

The claim matched, cleared its other edits, and remitted. Or it hit a mismatch and denied with no matching data.

The leaks live in the gaps between those four columns, and North Carolina has two rules that turn a gap into lost money: the EVV claim-to-visit hard match denies any line where the service code, modifiers, or units do not agree with the accepted visit and the authorization, and the FFS 365-day filing window is only 180 days on managed care and secondary and crossover claims.

01
Delivered but never billed
02
EVV visit that does not match the claim on code or modifier
03
In-home line billed as units when the auth was per diem, or vice versa
04
Denied for no matching data and never reworked
05
Aged past the 180-day managed care window

Illustrative findings

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.

Finding A

99509 unit mismatch, silent shortfall

21 in-home PCS claims paid clean this quarter where the accepted EVV visit shows more delivered 15-minute units than the claim billed. Example: a visit accepted for 12 units of 99509 HA, claim billed 10. The claim matched and paid, so nothing flagged, but 2 units per visit across 21 visits is 42 units of delivered care that never turned into a claim line. Records attached, ready to check against your contracted rate.

Finding B

Modifier mismatch, denied and not reworked

15 denied claim lines where the modifier on the claim does not match the modifier on the accepted EVV visit or the authorization. Example: the visit and auth carry HA, the claim submitted with HB. Twelve of the fifteen are inside the plan appeal window and reworkable today. The other three are past it.

Finding C

Authorization ceiling versus delivery

3 clients where delivered and accepted EVV units exceed the authorized PCS units 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, so you can see the exposure and fix the auth going forward rather than quote it as money owed.

Finding D

Timely-filing risk, the managed-care 180

19 delivered-and-accepted EVV visits with no matching claim found in the export, sorted by date of service against the payer's filing clock. 9 are on managed care plans still inside the 180-day window and billable now. 6 are between 180 and 365 days, gone on the plan and only workable if they are FFS. 4 are past 365 and gone everywhere. The list is ranked by days remaining.

Finding E

Congregate per-diem billed as units

5 congregate PCS lines dated on or after April 1, 2025 that were billed with a unit count instead of the new per diem, or with the wrong congregate modifier among HC, TT, SC, or HH. 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.

The blind spot

Why an annual audit or the EMR alone misses this.

A once-a-year audit looks back over twelve months. In North Carolina the money has a 180-day clock on managed care. By the time an annual review names a denied line, the plan window may be shut and the FFS window well down the road too. By the time a yearly review reaches a denied line, the plan appeal window has usually closed.

The EMR is not built to catch it either. Your EMR knows what it billed. The EVV aggregator, whether Sandata, CareBridge, or HHAeXchange, 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, because the claim matched the units it declared, not the units delivered.

The gap only shows when you put the accepted EVV transaction, the claim, and the remittance in the same view and read them together, per payer, per clock. That is the one thing Reeve does. It reads across the seam.

That is what Reeve reads for in North Carolina: what your EVV aggregator accepted, what the authorization allowed, what you billed, and what actually paid, read against each other rather than audited for rate.

Questions

Plain answers, on the record.

Straight answers on how the North Carolina Margin Review works, what it touches, and what it will not claim.

01 Is Reeve going to tell me a dollar figure for what I can recover in North Carolina?: 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.
02 Does 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.
03 What North Carolina rule is Reeve actually reconciling against?: The EVV claim-to-visit hard match and the authorization ceiling under Clinical Coverage Policy 3L. A PCS claim that does not line up with an accepted EVV visit on service code, modifiers, and units, or that exceeds the authorized amount, denies with no matching data. Reeve lines up the visit, the claim, and the remittance and shows you which field disagrees.
04 Which North Carolina programs and codes does this cover?: State Plan Personal Care Services under Clinical Coverage Policy 3L for in-home and 3L-1 for congregate, plus CAP/DA, CAP/C, and Innovations waiver attendant hours. In-home PCS bills on 99509 with HA or HB in 15-minute units. Congregate PCS uses HC, TT, SC, or HH and shifted to a per diem effective April 1, 2025.
05 We route EVV to Sandata, CareBridge, and HHAeXchange depending on the payer. Do we need to consolidate?: No. Reeve reads the exports those aggregators produce and reconciles each one against the claims and remittances for its payer. NC Medicaid Direct through Sandata, Healthy Blue through CareBridge, Standard and Tailored Plans and LME-MCOs through HHAeXchange. It sits above your stack, read-only.
06 How does the FFS 365 versus managed care 180 filing rule show up in the review?: Reeve sorts findings by the operative clock for each payer. FFS lines get 365 days. Managed care and secondary and crossover lines get 180. 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.
07 Who 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.

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.

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.

Start my free Margin Review

01
Read-only. Reeve reads your export and does not write to your EMR, does not file a claim, does not move money.
02
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.
04
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.