Medicaid Home Care Billing Software
Medicaid and waiver billing depends on authorizations and EVV visit data matching the claim. Porchlight bills from verified visits and checks the claim against the authorization before submission.
How Medicaid billing works
The path is the same shape in each program: an authorization, a visit, a claim, then payment back. Rules vary by state and program. This page does not list state-by-state claim rules.
- An authorization is stored on the client.
- A visit is logged. [CONFIRM: the visit must be EVV-verified before a claim is built?]
- Porchlight builds a claim from that visit and runs pre-submission claim checks against the authorization.
- The payer returns a remittance. [CONFIRM: 835 remittance posting?]
What Porchlight checks before submission
Pre-submission claim checks are part of the product. Which fields those checks compare is not confirmed item by item.
- [CONFIRM: units compared with the authorization?]
- [CONFIRM: rate on the claim?]
- [CONFIRM: service code?]
- [CONFIRM: EVV match?]
- [CONFIRM: eligibility dates?]
After submission
What happens to a claim after it leaves the agency is only partly described. Logged visits still become the claim. The follow-up steps are open.
- [CONFIRM: track rejections?]
- [CONFIRM: correct and resubmit a rejected claim?]
- [CONFIRM: 835 support for posting remittance?]
EVV
Visit data has to reach billing before a waiver claim is trustworthy. [CONFIRM: how EVV visit data flows into billing, and which EVV aggregators or states are supported?]
Medicaid billing sits inside home care billing software. Private pay, long-term care insurance, and VA billing are covered by private duty home care billing software. What it costs is on home care billing software pricing.