Utah 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. Utah's 365-day timely-filing window is verified in Reeve against a primary source, and it is an absolute outer limit measured from the date of service: past it, a correction may still be accepted but no additional funds are reimbursed, so there is nothing left to recover. Denied-balance findings on a Utah book carry dollars. Reeve has read the Utah Aging Waiver schedule effective January 1, 2026 off the state's published PDF and holds it by code, unit, modifier, and effective date. That is the Aging Waiver, not everything: on a New Choices Waiver or State Plan line, Reeve prices from the rate on your own export or the rate your own remittances actually paid most often rather than assuming the Aging Waiver rate.
Every dollar of Utah Medicaid personal care passes through four states of being, and they do not always agree.
Utah Medicaid requires prior authorization for personal care services reported under T1019, and failure to obtain it results in denial of payment. Reeve reads whatever authorization export you bring and caps recoverable at what was actually authorized. Where there is no authorization, Reeve refuses to quote a dollar it cannot cap.
The aide worked the visit and it landed in the state's EVV system for personal care. The visit becomes an accepted EVV transaction, or it does not, and either way the claim has to line up with it.
A claim went out to Utah Medicaid with a Medicaid ID, date of service, NPI, a HCPCS code, and a unit count. Traditional PCS rides on T1019 per 15 minutes. 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. Denied claims that were already received by the payer still have a resubmission path, but in Utah the 365 days run from the date of service and do not restart: it is an absolute outer limit, not a rolling clock off the last remittance. Past it, a correction may be accepted and still reimburse nothing.
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
- 05Aged past the state filing window
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.
16 PCS claims paid clean this quarter where the accepted EVV visit shows more delivered quarter-hour units than the claim billed. Example: a visit accepted for 14 units of T1019, claim billed 10. The claim matched and paid, so nothing flagged, but 4 units per visit across 16 visits is 64 units of delivered care that never turned into a claim line. Records attached, ready to check against your contracted rate.
9 accepted EVV visits for T1019 with no corresponding line in the billing export. The care was given and the visit is on the record; the claim never went out.
3 members where delivered and accepted EVV units exceed the authorized units on file. This is not recoverable, and Reeve will not pretend it is. It surfaces separately as over-authorized delivery, care the people who deliver it gave that was never authorized, so you can see the exposure and fix the auth going forward rather than quote it as money owed.
14 paid T1019 lines where the per-unit rate came in below the modal rate your own remittances paid on that code this period. Sourced from your own data, not a published fee schedule Reeve has not verified.
15 delivered-and-accepted EVV visits with no matching claim found in the export, ranked by days remaining against Utah's 365-day window. The lines closest to the deadline are at the top; anything past it is marked gone.
Why an annual audit or the EMR alone misses this.
A once-a-year audit looks back over twelve months. By the time an annual review names a line that fell past the filing window, the money is gone and the schedule that caused the exposure has kept running. A once-a-year audit is a report on the past. Utah's filing clock does not wait for it.
The EMR is not built to catch it either. Your EMR knows what it billed. The state's EVV system 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.
The gap only shows when you put the accepted EVV transaction, 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 in Utah: what your EVV records show, what the authorization allowed, what you billed, and what actually paid, read against each other rather than audited for rate.
Plain answers, on the record.
Straight answers on how the Utah Margin Review works, what it touches, and what it will not claim.
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.
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 does not write to your EMR, does not file a claim, does not move money.
- 02
Names coded locally. Names and member identifiers 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.