Ohio home care margin recovery, starting with the EVV gap nobody is watching.
You delivered the visits. Your caregivers clocked in and out. But between the Sandata aggregator, the no match, no pay edits, and a 365-day filing clock, some of that care never turned into a clean paid claim. Reeve is a free, read-only Margin Review that runs in your own browser and shows you exactly where authorized, delivered, billed and paid stop agreeing.
Every home care dollar in Ohio passes through four columns. When they all agree, you get paid for the care you gave. When they drift apart, the money sits in the gap. Reeve lines up all four on an export you already have and shows you the rows where they stop matching.
What the payer approved: a plan of care and a prior authorization under a specific program, from the Ohio Home Care Waiver and PASSPORT to the MyCare Waiver, State Plan Home Health, or a DODD waiver. Personal care aide service bills as T1019, in 15-minute units, often with modifiers like HQ, TU, UA, U2 or U3. Authorization is a ceiling. Deliver above it and those hours are not recoverable, just unpaid.
What actually happened in the home. In Ohio this lives in Sandata, the state EVV aggregator, captured directly or fed in from an alternate EVV vendor. Ohio's match looks at six things: service type, recipient, date, location, caregiver, and start and end times. A visit has to reach Verified status before a clean claim can ride on it.
What you submitted to the payer or MCO. This is where the Ohio no match, no pay reality bites. The state moved from soft warnings to hard claim edits on a rolling schedule, and a claim that does not match a Verified visit in the aggregator does not pend for review the way it used to. It denies.
What the remittance actually returned. A submitted claim is not a paid claim. Denials for EVV mismatch, a lapsed or exhausted authorization, a wrong modifier, or a units disagreement all land here, and each one starts a clock against the 365-day Ohio Medicaid timely-filing limit.
The money does not leak in any one column. It leaks in the gaps between them.
- 01Delivered but not Verified: the visit happened, but it never cleared Sandata, so the matching claim denies or was never sent.
- 02Verified but not billed: a clean visit sitting in the aggregator with no claim riding on it.
- 03Billed but not paid: a no match, no pay denial, an authorization mismatch, or a modifier error that came back on the remit and was never worked.
- 04Delivered above authorized: hours over the approved ceiling, flagged separately and never counted as recoverable, because they are not.
Every number is illustrative and synthetic, built on Ohio billing mechanics, not results from any 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.
Why an annual audit or the EMR alone misses this in Ohio.
The timely-filing clock is faster than your audit cycle. Ohio gives you 365 days from the date of service. An annual audit, by definition, looks back across roughly that whole window, which means the oldest problems it finds are often already dead on arrival. Money leaks continuously and expires on a rolling basis.
Your EMR shows delivery, not the aggregator match. Your scheduling and billing system knows the visit happened and knows you sent a claim. What it does not natively reconcile is the three-way relationship between the authorization ceiling, the Sandata Verified status, and the paid remittance.
Ohio's no match, no pay edits sit at the seam between systems, which is exactly the seam a single EMR cannot see across. A visit can look perfect in your EMR and still deny at the state because it never cleared the aggregator. Reeve reads across all of it at once, which is the only place the mismatch is visible.
A review you can run monthly, in minutes, on an export you already pull, is the difference between a rebill and a write-off.
Plain answers, on the record.
The Ohio mechanics behind the reconciliation, and how Reeve handles your data.
- 01What is Ohio's no match, no pay EVV policy?
- It means a Medicaid claim that does not match a verified EVV visit in the state's Sandata aggregator is denied rather than paid and reviewed later. Ohio phased in these hard claim edits by program: State Plan Home Health starting in 2025, the DODD waivers on October 1, 2025, PASSPORT and the Ohio Home Care Waiver on January 1, 2026, and MyCare Ohio on March 1, 2026. Reeve helps you find delivered visits that never reached Verified before they cost you a denial.
- 02Which EVV system does Ohio Medicaid use?
- Ohio uses Sandata as the state EVV aggregator. Agencies can capture visits directly in Sandata or use an approved alternate EVV vendor that feeds data into the Sandata aggregator. A visit generally needs to reach Verified status before a clean claim can be paid against it.
- 03How long do I have to file a Medicaid claim in Ohio?
- The standard Ohio Medicaid timely-filing window is 365 days from the date of service, under Ohio Administrative Code 5160-1-19. That clock is why a denial you catch quickly is a rebill, and the same denial found in an annual look-back can be past the window and unrecoverable. Reeve sorts your unpaid records by how many days are left on that clock.
- 04Does Reeve send claims or fix things in my system?
- No. Reeve reads, it does not write. It does not file claims, it does not move money, and it does not touch your EMR or Sandata. It produces a coded worklist of the exact records where authorized, delivered, billed and paid disagree, and your team or biller acts on it.
- 05Will Reeve tell me the dollar amount I can recover in Ohio?
- 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 Ohio 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.
- 06What data do I need to run a Reeve Margin Review?
- An export you already pull from your EMR and EVV system covering authorizations, delivered visits, billed claims and remittances. The review runs in your own browser. Your file is coded locally before any of the math runs, and no name is written into any output.
- 07Which Ohio programs and codes does this cover?
- The reconciliation applies across the Ohio programs that carry EVV and prior authorization, including the Ohio Home Care Waiver, PASSPORT, the MyCare Waiver, State Plan Home Health, and the DODD waivers. Personal care aide service is commonly billed as T1019 in 15-minute units with modifiers such as HQ, TU, UA, U2 and U3, and Reeve checks those against the delivered EVV record.
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.
Run the Margin Review on your own numbers. It is free, it is read-only, and there is no call to book first. You bring an export you already have, and Reeve shows you where authorized, delivered, billed and paid stop agreeing, with the record attached to every finding.
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It runs in your own browser, on an export you provide, and your data is coded locally before any of the math runs.
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Nothing with a name, address, or Medicaid ID on it leaves your building.
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Reeve reads. It does not write, does not file a claim, does not move money.
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You get a ranked worklist of records to check against your own rate sheet.
No salespeople and no promises attached. All example findings are illustrative and built on Ohio billing mechanics, not results from any agency.