South Dakota home care margin recovery.
You delivered the visits. Reeve reads your own billing export, right in your browser, and lines up authorized, delivered, billed, and paid side by side so the gaps between them have a record attached. South Dakota's filing window is verified in Reeve against a primary source and it is month anchored rather than day anchored: South Dakota Medicaid must receive a completed claim within 6 months following the month the services were provided. Reeve has read the South Dakota personal care, ADLS Waiver, HOPE Waiver, and home health schedules effective July 1 2026 and holds them by code, unit, modifier, and effective date. South Dakota pays the lesser of your usual and customary charge or the published maximum, so Reeve prices at the lesser of the two rather than treating the published number as what you were owed.
Every dollar of South Dakota Medicaid personal care passes through four states of being, and they do not always agree.
The payer approved a number of units. Reeve reads whatever authorization export you bring and caps recoverable at what was actually authorized. Where there is no authorization in the file, Reeve refuses to quote a dollar it cannot cap.
The aide worked the visit and it landed in your visit record. South Dakota bills personal care in quarter hours, and a visit shorter than 8 minutes is not underbilled, it is unbillable, so Reeve holds an 8-minute increment floor and rounds to the nearest 15 minutes above it rather than inventing a partial unit.
A claim went out to South Dakota Medicaid with a Medicaid ID, date of service, NPI, a HCPCS code, and a unit count. Personal care rides on T1019 per 15 minutes, homemaker on S5130, attendant care on S5125, respite on T1005. 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. South Dakota gives 3 months to correct a denied claim, measured from the denial notice, and 3 months to adjust or void a paid claim. Those are separate clocks from the 6-month initial window and they do not extend it.
The leaks live in the gaps between those four columns, and Reeve reads across all four rather than trusting any one system's view.
- 01Delivered but never billed
- 02Billed fewer units than the visit shows
- 03Billed at a rate below your own paid modal on the same code
- 04Denied and unbilled since, with the 3-month correction clock running
- 05Aged past the 6-month window that closes at the end of the month of service
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.
Why an annual audit or the EMR alone misses this.
A once-a-year audit looks back over twelve months, and South Dakota's initial window is 6 months following the month of service. By the time an annual review names a line that fell past the window, the money is gone and the schedule that caused the exposure has kept running. The audit tells you what you lost. It does not tell you in time to get it back.
The EMR is not built to catch it either. Your EMR knows what it billed. The visit record knows what was delivered. The remittance knows what paid. Those three live in three places, and the mismatch is in the seam between them.
The gap only shows when you put the visit, the member's authorization, the claim with its code, 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. Not a rate audit. A reconciliation of what your own systems already say happened.
Plain answers, on the record.
Straight answers on how the South Dakota Margin Review works, what it touches, and what it will not claim.
- 01Is Reeve going to tell me a dollar figure for what I can recover in South Dakota?
- Only where it can stand behind it. South Dakota pays the lesser of your usual and customary charge or the published maximum, so Reeve prices at the lesser of the rate in your own data and the published fee it holds, and it says so on the finding. Where your export carries no charge, Reeve discloses that the lesser-of rule could not be applied and gives you the hours, the units, and the exact records instead of a dollar figure.
- 02Does 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 tokenized locally before any math runs. Nothing with a name on it is uploaded or sent anywhere. Reeve reads. It never writes to your EMR, never files a claim, and never moves money.
- 03What is the South Dakota filing window, exactly?
- South Dakota Medicaid must receive a completed claim within 6 months following the month the services were provided. It is month anchored, not day anchored, so the clock runs from the end of the month of service rather than from the date of the visit. Correction of a denied claim runs 3 months from the denial notice, and adjust or void of a paid claim runs 3 months. Third party and Medicare coordination runs 6 months from the payment or denial notice, and retroactive eligibility runs 6 months. That is verified in Reeve against ARSD 67:16:35:04 and the South Dakota Medicaid General Claim Guidance, and the citation is printed on the report.
- 04Which South Dakota rates does Reeve hold?
- The personal care agency, ADLS Waiver, HOPE Waiver, and home health schedules effective July 1 2026, held by code, unit, modifier, and effective date, along with the state's authorized modifier table with its own separate effective date. South Dakota publishes by state fiscal year, so Reeve tracks the July 1 boundary and will tell you when the schedule it holds may have been superseded rather than quietly pricing off a stale document. Where the state prints two different dollars under the same key, such as the residential per diems that differ by program, Reeve refuses to pick one and says the key is incomplete.
- 05How does the 8-minute increment floor show up?
- South Dakota bills in 15-minute increments. A visit under 8 minutes is not underbilled, it is unbillable, so Reeve returns zero units on it rather than calling it a shortfall. Above the floor, Reeve rounds to the nearest quarter hour and discloses that the rounding happened when your export carries hours rather than minutes.
- 06Who 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.
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.
- 01
Read-only. Reeve reads your export and never writes to your EMR, never files a claim, never moves money.
- 02
Tokenized locally. Names and Medicaid IDs are tokenized 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 de-identifies it before any math runs. Every example figure is illustrative and synthetic, method rather than results, and Reeve makes no guarantee of recovery.