Find out why a DODD claim will deny before you submit it.
ClaimYours AI checks every claim against Ohio’s DODD rules the moment it arrives, shows you the rule and where it comes from, and proposes the fix. You approve it. You upload it to eMBS. Nothing leaves without a person pressing the button.
How DD waiver billing works in Ohio
Ohio’s developmental disabilities waivers are run by DODD with Ohio Medicaid. County boards plan and authorize the services; providers bill DODD for what was delivered.
The waivers
Individual Options (IO), Level One and SELF are Ohio’s DD waivers. Each sets which services a person can receive and the limits that apply.
County boards
The county board of developmental disabilities works with each person on their service plan and sets up the authorizations providers bill against.
PAWS
Authorizations live in PAWS, DODD’s payment authorization system. A line can only pay for the service, units and dates the authorization covers.
eMBS
Providers send claims to DODD through eMBS, usually as a flat file, then read the return reports to see what paid and what was rejected.
EVV
Ohio requires electronic visit verification for some waiver services. Those visits are recorded in Sandata, and the claim has to match the visit.
Rates
Rates come from the OAC 5123-9 rate appendices and depend on the service, the county’s rate category and details such as group size.
Where the money goes missing
- Units billed above what the PAWS authorization allows
- Visits with no matching EVV record
- A rate billed under the wrong county category or service code
- A staff credential that lapsed before the date of service
- Rejected lines on the return report that nobody reworks
Where ClaimYours AI fits
ClaimYours AI reads your flat file and return reports, checks every line against Chapter 5123-9, PAWS and EVV, and stages the corrected file for you to upload to eMBS.
How a denied claim becomes a paid one
Six steps. Two of them belong to a person on your team.
Step 1: Arrive
A claim is typed in or uploaded in a batch.
Step 2: Checked
Every rule runs the moment it lands, and each result shows its source.
Step 3: Fix proposed / Fact requested
If we know the fix, we propose it. If a fact is missing, we ask the right person.
We know the fixA fact is missingStep 4: Approved
A person on your team reviews and approves. One click.
Step 5: Submitted
You upload the staged file to eMBS yourself. We never submit for you.
Step 6: Paid
Return reports stamp paid lines. Denied lines come back with the reason.
When we know the fix, we propose it
Wrong rate, wrong county, wrong units, wrong code: you see what was billed, what it should be, and the source. One click to approve.
When a fact is missing, we ask for it
No PAWS authorization on file, no EVV visit, a lapsed DSP credential: the ask goes to the right place, your county board or your own staff, by email, or by text where the person has agreed to texts. The claim is re-checked automatically when the answer comes back.
Approved claims become a file you submit
Approved claims flow to Submit files: sorted the way eMBS wants, built into the flat file, pre-flight checked, and downloaded as a ZIP with a Summary of Changes. You upload it to eMBS.
The rules behind a DODD denial
Checked against the rule registry, with each rule marked verified or advisory. Nothing is a black box: every result shows the rule, what it looked at, and where the rule comes from.
eMBS error codes
The codes eMBS returns, mapped to the rule behind them and what to do about each one.
OAC 5123-9 service rules
The service rules in Ohio Administrative Code Chapter 5123-9, applied line by line.
County rate tables
All 88 counties mapped to their rate categories, so the rate billed is compared with the rate that applies.
PAWS authorizations
Units billed against the authorization on file, before eMBS denies the overage.
EVV (Sandata) visits
Services that need electronic visit verification matched to a visit record.
DSP credentials
Staff certification dates checked against the date of service.
Timely filing
The filing clock tracked per claim, with early warning as it runs down.
Duplicates
Lines that repeat a claim already billed or paid.
Unit caps
Daily and per-service unit limits, so a cap is caught before it becomes a denial.
Recover
Short pays and underbilling found against the county rate table: billed versus correct rate, the variance, the source, and a proposed adjustment claim.
Return reports
Paid lines are stamped PAID with the dollars recovered. Denied lines return to the work queue with the reason.
Compliance
PAWS authorizations, the rule registry, a full audit trail, and a work log of who did what, when, on which claim.
Service coverage. All 34 services in OAC Chapter 5123-9 are in the service catalog. Rate checks run where the rate has been verified against the published appendix, and ClaimYours AI says plainly when a rate has not been verified yet. It never guesses a rate.
Staging, not auto-submission
It never submits for you
You approve every change and you upload the file to eMBS yourself. Nothing leaves your workspace without a person pressing the button.
It never collects PHI on this site
Our forms refuse patient names, Medicaid IDs and dates of birth. Uploads happen only inside ClaimYours AI, after your account is approved and the Business Associate Agreement is accepted.
It never hides a rule
No black-box scoring. Every result names the rule, what it looked at, and the OAC cite, rate appendix or eMBS code it comes from.
Built for the people who bill DODD
DODD waiver providers
Agencies that bill Ohio’s DODD waivers and want to stop finding out about problems from a denial.
HPC, IO and Level One agencies
Homemaker/personal care, Individual Options and Level One providers, where county rates, authorizations and visit records all have to line up.
Billing companies
Teams that bill for DODD providers and need every claim checked, with a record of who approved what.
Three problems every billing office knows
Claims sit denied for weeks
A denial shows up days after you submit, then waits in a queue until someone has time to work out why.
Nobody knows which rule failed
A denial code tells you something is wrong. It rarely tells you which rule, or what to change.
Adjustments never get filed
Short pays and underbilling are easy to miss, and easy to put off until the window closes.
Made around the systems DODD providers actually use
Waiver billing in Ohio runs on DODD rules, county boards and eMBS. ClaimYours AI is built on the same ones.
DODD
The service rules in Chapter 5123-9 of the Ohio Administrative Code: all 34 services, applied line by line.
Rate appendix
Every rate traced to the OAC 5123-9 rate appendix, so an underbilled unit shows its source.
County boards
All 88 Ohio counties are mapped to their rate categories, and requests for missing facts can go to your county board.
PAWS
Units billed are checked against the PAWS authorization on file, before eMBS denies the overage.
Sandata EVV
Services that need electronic visit verification are matched to a Sandata visit record.
eMBS
Corrected claims are staged in the flat-file format eMBS expects, and eMBS return codes map to the rule behind them. You upload the file yourself.
Patient data stays inside the platform
From sign-up to your first checked claim
Sign up
Create an account, or start with the demo to see the platform first.
Approved
A person at ClaimYours AI reviews and approves your account.
BAA accepted
Your practice accepts the Business Associate Agreement inside the platform.
Upload & check
Upload claims inside your account and see every result with its source.
See how every claim gets checked.
Try the demo yourself, or ask for a walkthrough. No patient information needed.