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

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 Wisconsin rules is Reeve actually reconciling against?

Three: the Sandata EVV match on EVV-listed codes, the prior authorization requirement for state-plan personal care beyond the initial units, and the program-versus-code discipline across state-plan PC, IRIS, Family Care, and Partnership. Reeve lines up the visit, the PA, the code, the claim, and the remittance and shows you where any of those disagree, inside the 365-day filing window.

Which Wisconsin programs and codes does this cover?

State-plan Personal Care under BadgerCare Plus and Medicaid, IRIS for self-directed members, and Family Care and Partnership for managed long-term care with Supportive Home Care. Codes include T1019 per 15 minutes for state-plan PC, T1020 per day inside Family Care, S5125 per 15 minutes and S5126 per day for Supportive Home Care, and 99509 per visit for live-in personal care.

We use another EVV vendor under the open model. Do we have to switch to Sandata?

No. Reeve reads the export your vendor and Sandata produce and reconciles them against your claims and remittances. It sits above your stack, read-only, and works with whichever open-choice EVV vendor you use.

How does the EVV-versus-non-EVV distinction show up in the review?

Reeve only expects a Sandata match on codes that are on the EVV list. For codes off the list, it will not flag the absence of an EVV record as a problem. That way you are not chasing a Sandata visit for a service that does not need one.

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.

Wisconsin home care margin recovery.

You delivered the visits. In Wisconsin, only the EVV-listed codes require EVV, state-plan personal care usually needs a prior authorization beyond the initial units, and the filing clock is 365 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 and supportive home care in Wisconsin passes through four states of being, and they do not always agree.

Authorized

The payer approved a number of units or days. In Wisconsin that is state-plan Personal Care under BadgerCare Plus and Medicaid, IRIS for self-directed members, or Family Care and Partnership for managed long-term care with Supportive Home Care. State-plan personal care generally requires a prior authorization beyond the initial units. The clock and the ceiling both live here.

Delivered

The aide worked the visit and it landed in Electronic Visit Verification. Wisconsin runs an open EVV model with Sandata as the state aggregator. Not every code is on the EVV list, so EVV applies to some services and not others. Where EVV applies, the visit becomes an accepted Sandata transaction, or it does not.

Billed

A claim went out to the correct payer with a Medicaid ID, date of service, NPI, and the right code for the program: T1019 per 15 minutes for state-plan personal care, T1020 per day inside Family Care, S5125 per 15 minutes and S5126 per day for Supportive Home Care, and 99509 per visit for live-in personal care. Getting the right code for the right program is where a lot of Wisconsin trouble hides.

Paid

The claim matched, cleared its other edits, and remitted. Or it hit a PA, EVV, or code mismatch and denied.

The leaks live in the gaps between those four columns, and Wisconsin has two rules that turn a gap into lost money: when the code is on the EVV list, the claim needs a matching accepted Sandata visit, and state-plan personal care usually needs a prior authorization beyond the initial units, so PA-versus-EVV-versus-claim mismatches deny even when the visit really happened.

01
Delivered but never billed
02
EVV-required code with no matching Sandata visit
03
Prior authorization missing on state-plan personal care beyond the initial units
04
Wrong code for the program, T1019 versus T1020, S5125 versus S5126, or 99509
05
Aged past the 365-day 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

T1019 unit mismatch, silent shortfall

17 state-plan personal care claims paid clean this quarter where the accepted Sandata visit shows more delivered quarter-hour units than the claim billed. Example: a visit accepted for 13 units of T1019, claim billed 11. The claim matched and paid, so nothing flagged, but 2 units per visit across 17 visits is 34 units of delivered care that never turned into a claim line. Records attached, ready to check against your contracted rate.

Finding B

Program-code mix-up, Family Care and Supportive Home Care

14 claim lines where the code did not match the program. Example: T1019 billed on a Family Care day where T1020 per day was correct, or S5125 per 15 minutes billed where S5126 per day was correct. Eleven of the fourteen can be rebilled today with the correct code. The other three are past the clock.

Finding C

PA missing beyond the initial units on state-plan PC

9 state-plan personal care lines that carried delivery beyond the initial units without a matching prior authorization on file. Denials this old are still workable on 7 of the 9 inside the 365-day filing window if the PA can be reconstructed. The 2 are exposure only.

Finding D

Authorization ceiling versus delivery

3 members where delivered and accepted Sandata units exceed the authorized units on file across programs. 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 auth going forward rather than quote it as money owed.

Finding E

Timely-filing risk, the 365-day shelf

17 delivered-and-accepted Sandata visits with no matching claim found in the export, sorted by date of service against the 365-day clock. 8 are still inside the window and billable now. 4 are inside a resubmission window on a prior denial. 3 are gone. The list is ranked by days remaining.

The blind spot

Why an annual audit or the EMR alone misses this.

A once-a-year audit looks back over twelve months. In Wisconsin the money has a 365-day clock, but the harder problem is that state-plan personal care, IRIS, Family Care, and Partnership each use their own codes and rules and the mismatch is easy to miss line by line. By the time an annual review names a wrong-code denial, the same code has been going out for months. The annual review is a scorecard. It arrives after the lines it grades are unbillable.

The EMR is not built to catch it either. Your EMR knows what it billed. Sandata knows what EVV-required visits were accepted. The PA record knows what was authorized beyond the initial units. The remittance knows what paid. Those four live in four places, and the mismatch is in the seams between them.

The gap only shows when you put the accepted Sandata transaction, the PA, the member's program with its correct code, the claim, 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 Wisconsin: what Sandata 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 Wisconsin 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 Wisconsin?: 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 Wisconsin rules is Reeve actually reconciling against?: Three: the Sandata EVV match on EVV-listed codes, the prior authorization requirement for state-plan personal care beyond the initial units, and the program-versus-code discipline across state-plan PC, IRIS, Family Care, and Partnership. Reeve lines up the visit, the PA, the code, the claim, and the remittance and shows you where any of those disagree, inside the 365-day filing window.
04 Which Wisconsin programs and codes does this cover?: State-plan Personal Care under BadgerCare Plus and Medicaid, IRIS for self-directed members, and Family Care and Partnership for managed long-term care with Supportive Home Care. Codes include T1019 per 15 minutes for state-plan PC, T1020 per day inside Family Care, S5125 per 15 minutes and S5126 per day for Supportive Home Care, and 99509 per visit for live-in personal care.
05 We use another EVV vendor under the open model. Do we have to switch to Sandata?: No. Reeve reads the export your vendor and Sandata produce and reconciles them against your claims and remittances. It sits above your stack, read-only, and works with whichever open-choice EVV vendor you use.
06 How does the EVV-versus-non-EVV distinction show up in the review?: Reeve only expects a Sandata match on codes that are on the EVV list. For codes off the list, it will not flag the absence of an EVV record as a problem. That way you are not chasing a Sandata visit for a service that does not need one.
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.