Home Care software for
Medicaid Agencies

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Home care agencies performing Medicaid-reimbursed services need special software to be effective. The best Medicaid home care software handles authorization units, electronic visit verification (EVV), claim submission.

Medicaid Authorizations

Your home care software needs to manage authorized units. Units are generally 15-minute blocks of care. Medicaid will tell you how many units of care you can deliver in a week month or other time period. You should schedule to use all authorized units without going over.

  • Authorized Unit Warnings
  • Auto-schedule to use all units
  • Prevent billing over authorization

All Medicaid programs require you to have home care software with electronic visit verification. This is a fraud prevention mandate signed into law in the 21st Century Cures Act. Visit our EVV page for more information. Key EVV features are as follows:

  • Mobile GPS App (that works off line)
  • Voice Telephony
  • EVV Token (FOB)
Medicaid Billing & Remittance

In order to bill Medicaid, your software needs to submit electronic claims or visit records that include proof of EVV. Ultimately the claims are processed by Medicaid or their chosen MCOs and you will receive payment accompanied by Electronic Remittance Advice. Then you need to reconcile your accounts. 

  • Medicaid Claims via EDI 837
  • Medicaid Remittance via EDI 835
  • Accounts Receivable Management
Medicaid State Requirements

Each state Medicaid program has different requirements for its home care agencies. This can include special rounding rules, care plans, specific EVV rules, claim submission rules, required documentation and more. Be sure to consult your state’s Medicaid site for specific rules. Here are some key features you should look for.

  • Multiple "services" in a single visit
  • Unit rounding rules (like Missouri "accrued minutes")
  • Special documents (like the Virginia DMAS90)

What to look for in Medicaid Home Care Software