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.
Reeve lines up your Sandata visit log against your delivered-visit records and finds, say, 240 visits over a quarter that show as delivered in your scheduling data but never reached Verified status in the aggregator. Every one is a candidate for a no match, no pay denial. The finding is a list of dates, caregivers and recipients, shown as coded references, so your biller can fix the exception at the source.
Reeve finds 60 visits that cleared Sandata as Verified but have no matching billed claim. That is delivered, compliant care that simply never got submitted. Reported as a count of visits and total 15-minute units of T1019, tied to specific records, for you to price against your own contracted rate.
Reeve spots a recipient whose authorization was approved for 20 hours a week, where delivered hours ran to 26 for three weeks running. The 6 extra hours a week are over the ceiling and are not recoverable, and Reeve labels them that way plainly. What is recoverable is the pattern: a lapsed or under-sized auth that should have been renewed before the care was given.
Reeve sorts your unpaid and denied lines by date of service against the 365-day filing limit and shows, for example, 45 denied claim lines with fewer than 60 days left on the clock. These are the ones to work first, because past the window they are unrecoverable no matter how clean the underlying visit was.
Reeve finds visits where the billed T1019 units or a modifier, say a missing TU overtime or a U2 second-visit-same-day, do not line up with the delivered EVV record, a common quiet source of underpayment and downstream denial. Reported as a list of records where the billed units or modifier disagree with the delivered visit.
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.
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.