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

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 Tennessee rule is Reeve actually reconciling against?

The CareBridge EVV reconciliation to the MCO and the 120-day MCO filing clock. A claim that does not line up with an accepted CareBridge visit passed through to the correct MCO on member, code, and units does not pay, and a claim filed after 120 days is generally gone. Reeve lines up the CareBridge record, the MCO of record, the claim, and the remittance and shows you where any of those disagree.

Which Tennessee programs and codes does this cover?

TennCare LTSS through CHOICES and I/DD through ECF CHOICES, delivered by BlueCare, Amerigroup or Wellpoint, and UnitedHealthcare. Common codes are T1019 for personal assistance and personal care, S5125 for attendant care per 15 minutes, and S5150 for respite.

We already report through CareBridge. Does Reeve replace it?

No. Reeve reads the exports CareBridge and your MCOs produce and reconciles them against your claims and remittances. It does not replace CareBridge, does not write to it, and does not touch the MCO submission itself. It sits above your stack, read-only.

How does the 120-day rule show up in the review?

Reeve sorts findings by the 120-day MCO clock. Delivered visits inside the window are billable now and go to the top. Lines past 120 days are only workable with an MCO good-cause exception and Reeve marks them clearly. Lines well past that are marked gone rather than dressed up.

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.

Tennessee TennCare home care margin recovery.

You delivered the visits. In Tennessee, TennCare LTSS runs through the MCOs, EVV funnels through CareBridge, and the filing clock is only 120 days. 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.

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The four numbers

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

Authorized

The payer approved a number of units. In Tennessee that is TennCare long-term services delivered through the member's MCO, BlueCare, Amerigroup or Wellpoint, or UnitedHealthcare, under CHOICES for LTSS and ECF CHOICES for members with I/DD. Personal care, personal assistance, attendant care, and respite are authorized by the MCO for the member. The clock and the ceiling both live here.

Delivered

The aide worked the visit and it landed in Electronic Visit Verification. Tennessee runs all EVV through CareBridge, the state aggregator, which passes verified visits through to the MCOs. The visit becomes an accepted CareBridge transaction, or it does not, and the claim has to reconcile through CareBridge to the MCO.

Billed

A claim went out to the member's MCO with a Medicaid ID, date of service, NPI, a HCPCS code, and a unit count. Personal assistance and personal care ride on T1019, attendant care on S5125 per 15 minutes, and respite on S5150. Units are counted in quarter hours on the 15-minute lines, so small miscounts add up fast.

Paid

The claim matched, cleared its other edits, and remitted from the MCO. Or it hit a mismatch and denied.

The leaks live in the gaps between those four columns, and Tennessee has two rules that turn a gap into lost money: EVV visits have to reconcile through CareBridge to the correct MCO on member, code, and units, and the MCO filing clock is only 120 days from date of service, which is the sharpest window in the region.

01
Delivered but never billed
02
CareBridge visit not passed through to the correct MCO
03
Code mismatch between T1019, S5125, and S5150
04
Billed fewer units than the visit shows
05
Aged past the 120-day MCO filing 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

Unit mismatch on T1019 and S5125, silent shortfall

19 claims paid clean this quarter where the accepted CareBridge visit shows more delivered quarter-hour units than the claim billed. Example: a visit accepted for 11 units of S5125, claim billed 10. The claim matched and paid, so nothing flagged, but 1 units per visit across 19 visits is 19 units of delivered care that never turned into a claim line. Records attached, ready to check against your contracted rate.

Finding B

Code mismatch, personal assistance billed as attendant care

11 claim lines where T1019 was billed on a member authorized for S5125 attendant care, or the reverse. The MCO matches code to authorization, so the miscoded lines denied. Nine of the eleven are still inside the 120-day window and reworkable today. The other two are past the clock.

Finding C

Authorization ceiling versus delivery

3 clients where delivered and accepted CareBridge units exceed the authorized MCO units on file under CHOICES or ECF CHOICES. 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 MCO authorization going forward rather than quote it as money owed.

Finding D

Timely-filing risk, the 120-day MCO shelf

22 delivered-and-accepted CareBridge visits with no matching claim found in the export, sorted by date of service against the 120-day MCO clock. 12 are inside the window and billable now. 6 are past 120 and only workable if the MCO grants a good-cause exception. 4 are gone. The list is ranked by days remaining.

Finding E

CareBridge pass-through failure to the MCO

5 visits where the CareBridge record is accepted but did not pass through cleanly to the correct MCO for the member, most often because of an MCO-of-record change or a member-eligibility gap. 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 Tennessee the money has a 120-day MCO clock. By the time an annual review names a denied line, the MCO window has been shut for most of the year and the reason is lost. A yearly review names the denial after the 120-day window has already closed on it.

The EMR is not built to catch it either. Your EMR knows what it billed and which MCO it went to. CareBridge knows what visit was accepted and passed through. The MCO 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, or when the MCO of record changed mid-month.

The gap only shows when you put the accepted CareBridge transaction, the MCO of record, the claim with its code, and the remittance in the same view and read them together against the 120-day clock. That is the one thing Reeve does. It reads across the seam.

That is what Reeve reads for in Tennessee: what CareBridge accepted, what the authorization allowed, what you billed, and what actually paid, read side by side rather than audited for rate.

Questions

Plain answers, on the record.

Straight answers on how the Tennessee 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 Tennessee?: 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 Tennessee rule is Reeve actually reconciling against?: The CareBridge EVV reconciliation to the MCO and the 120-day MCO filing clock. A claim that does not line up with an accepted CareBridge visit passed through to the correct MCO on member, code, and units does not pay, and a claim filed after 120 days is generally gone. Reeve lines up the CareBridge record, the MCO of record, the claim, and the remittance and shows you where any of those disagree.
04 Which Tennessee programs and codes does this cover?: TennCare LTSS through CHOICES and I/DD through ECF CHOICES, delivered by BlueCare, Amerigroup or Wellpoint, and UnitedHealthcare. Common codes are T1019 for personal assistance and personal care, S5125 for attendant care per 15 minutes, and S5150 for respite.
05 We already report through CareBridge. Does Reeve replace it?: No. Reeve reads the exports CareBridge and your MCOs produce and reconciles them against your claims and remittances. It does not replace CareBridge, does not write to it, and does not touch the MCO submission itself. It sits above your stack, read-only.
06 How does the 120-day rule show up in the review?: Reeve sorts findings by the 120-day MCO clock. Delivered visits inside the window are billable now and go to the top. Lines past 120 days are only workable with an MCO good-cause exception and Reeve marks them clearly. Lines well past that are marked gone rather than dressed up.
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.