Billing

You're Not a Biller. But Right Now, You're Doing the Billing.

Jackie is billing on QuickBooks — Denise told her to stop, and she was right. Denise has Lisa submitting claims while the denied ones pile up, because neither of them knows how to appeal an MCO denial. CareBravo delivers billing as completed work: pre-submission review on every claim, specialist follow-through on every denial. The biller you need, without the $40,000 hire.

See What My Agency Is Losing → All Nine Functions →
What Unmanaged Billing Costs

The Denial Pile Isn't a Backlog. It's Revenue From Visits That Already Happened.

Denise did the math once on a slow Sunday. At 90 patients submitting 1,200+ claims a month, a 12% denial rate produces nearly 150 denials. She reworks maybe 50. The other 100 sit in a pile. Each one is a visit that happened, a caregiver who showed up, care that was delivered. The revenue already exists — it's just not being collected. At 30 patients, Jackie's version of this problem is proportionally smaller but proportionally just as expensive. And for Tasha, who is choosing her billing setup before her first claim: this is what you're building to prevent.

CareDrain™ recovered by this function — per month at 30 patients Estimates scale by patient count. Actual recovery depends on agency size and operational setup.
~$1,100 / month
How CareBravo Delivers It

Every Claim Reviewed Before It Leaves. Every Denial Worked by Someone Who Knows Your Payer.

CareBravo's billing function reviews every claim before submission — EVV match, authorization status, service code accuracy, caregiver credential currency, care plan alignment. Errors caught before submission take two minutes to correct. The same error caught after denial takes 30-50 minutes to rework, and two-thirds of them never get worked at all. For claims that are denied despite pre-submission review, CareBravo's billing specialists know your MCO-specific appeal processes — not just the generic denial code, but the specific documentation each payer requires to reverse each denial type. The work gets done. The pile doesn't form.

What arrives as completed work

Every claim reviewed before submission — EVV match, authorization status, service code, caregiver credential, care plan alignment. Errors caught and corrected before the claim reaches the payer. Denied claims worked by specialists who know your MCO's appeal process.

What your team does instead

Review the pre-submission summary. Approve clean batches. Focus on exceptions that require clinical judgment. The denial pile doesn't form because the errors are caught before submission.

What connects to this function

Billing connects to authorization management — claims are checked against current authorization status before submission. Billing connects to EVV — the EVV record is part of the pre-submission check. Billing connects to credentialing — caregiver credential status is verified for each claim.

What this looks like at your stage

At 30 patients: Jackie is billing on QuickBooks and losing money on every unworked denial. At 90 patients: Denise's denial pile represents tens of thousands of dollars in uncollected revenue from visits that already happened. Pre-launch: billing setup with pre-submission review from the first claim means you never develop the denial backlog that costs established agencies so much.

100+ agencies. 73% average revenue growth. No added back-office hires. The ~$1,100/month in Claims Drain that billing recovers at 30 patients is one component. The more important number is what agencies stop losing when pre-submission review becomes routine.

Questions

What Agency Owners Ask About Billing

Medicaid home care billing involves submitting claims to the state Medicaid agency or the patient's Managed Care Organization (MCO) for each authorized visit delivered. Each claim must include the correct service code, the caregiver's National Provider Identifier (NPI), EVV verification data, and documentation that the service matched the patient's care plan and authorization. Claims that don't meet payer specifications are denied. Denied claims must be corrected and resubmitted within the payer's timely filing window or the revenue is permanently lost.

The most common causes of Medicaid home care claim denials are EVV mismatch, expired or inactive authorization, incorrect service code, caregiver credential gap, and care plan mismatch. Most denials are preventable if the claim is reviewed against these criteria before submission. Agencies without pre-submission review typically see 10-15% denial rates; those with systematic pre-submission review see materially lower rates.

Timely filing is the deadline by which a Medicaid claim must be submitted after the date of service. Most state Medicaid programs and MCOs have timely filing limits of 90 days to one year. Claims submitted after the timely filing deadline are denied permanently — no appeal, no exception. Agencies with large denial backlogs risk losing revenue when older unworked denials cross the timely filing limit while the agency is focused on newer claims.

Medicaid billing requires specialist knowledge — correct service codes per payer contract, authorization matching, EVV compliance, MCO-specific denial appeal processes, and timely filing management. Most small agencies can't afford a dedicated biller ($40,000-$45,000/year plus benefits) but can't afford the revenue losses that come from billing without one. CareBravo delivers billing as a managed function — pre-submission review and denial management included — at a fraction of the cost of a full-time hire.

Billing software submits claims but requires someone with billing knowledge to operate it, review denials, and manage appeals. A billing service provides the specialist to do that work. CareBravo delivers billing as part of a connected operational system — meaning the pre-submission review has access to EVV records, authorization data, and caregiver credentials in the same system, producing a more comprehensive check than a standalone billing service working from claim data alone.

See What Pre-Submission Review Changes for Your Claims.

The diagnostic shows your current denial rate and what the unworked denials cost per month. The first call shows what billing looks like as completed work — pre-submission review running on your real claims data.

Book a Demo →
Why Medicaid home care claims get denied → See your full Claims Drain estimate → How authorization connects to billing → How EVV connects to claim accuracy →