Home Health
Home health claims, checked line by line.
Home care billing lives on waiver rules, visit records and authorizations that have to agree before a claim pays. ClaimYours AI checks every line against the EVV visit and the service plan before it goes out, and what you were paid against what you were owed after.
How home care billing works in Ohio
Home care for older adults and people with disabilities in Ohio is paid through several Medicaid programs. Each has its own case manager, service plan and rules.
PASSPORT
Ohio’s Medicaid waiver that helps older adults receive care at home instead of a nursing facility, run by the Ohio Department of Aging through regional Area Agencies on Aging.
Ohio Home Care Waiver
ODM’s waiver for people with disabilities or serious illness who need care at home, with services set in each person’s plan.
MyCare Ohio
For people with both Medicare and Medicaid. A managed care plan coordinates their services and pays the claims.
The service plan
Each person’s case manager sets the services, units and providers. A claim can only pay what the plan authorizes, billed to that program.
EVV
Ohio requires electronic visit verification for services such as personal care and home health aide visits. ODM’s EVV system is run by Sandata.
Medicare episodes
Medicare home health episodes are billed on the institutional claim (837I). ClaimYours AI covers the Medicaid waiver and plan claims today.
Where the money goes missing
- Visits billed with no matching EVV record
- Units above what the service plan allows
- A service billed to the wrong program
- Medicaid billed before Medicare or another primary payer
- Lines paid below your contract rate
Where ClaimYours AI fits
ClaimYours AI checks every line against the verified visit and the service plan before it goes out, and compares what you were paid with your contract afterwards.
The claims engine works for home care now
Upload your professional claims, remittances and payer contracts. Every line is compared, expected versus paid, and every fix waits for a person on your team.
Connect
Upload or connect your claims, remittances and payer contracts. Works from the files your clearinghouse and EHR already produce (837, 835, 999, 277CA); direct connections are set up and tested with each practice and vendor.
Compare
Every line checked: expected vs paid, against your contract or your payer’s real history.
Propose
We draft the fix, the appeal, or the records packet, with the reason and the source.
Approve
One inbox. One click. Tracked until the money lands.
Built for how you bill
Each item is marked as available now, in build, or coming next. We do not describe a feature as live until it is.
Paid below your contract
Each paid line is compared with your contract rate, or with what the payer has really paid you, and the difference is traced to its source.
Denials sorted by reason
Every denial is placed in one bucket from its reason code: underpaid, denied, timely filing, authorization missing, eligibility, bundled, duplicate or records requested.
Appeals and records packets
Appeal letters and records packets are drafted with the reason and the source. A person approves each one.
Authorization tracking
Authorizations on file show units authorized, used and remaining, with a view of the ones about to expire.
Filing clock per payer
Set each payer’s filing window once and see the days left on every claim.
Provider status on the date of service
Each claim’s rendering provider is checked against your roster. An NPI deactivated before the date of service, a confirmed exclusion or a payment suspension holds the claim; a possible match waits for a person.
Medicaid billed last
A claim that bills Medicaid as the secondary payer is held until the primary payer’s answer is on file.
EVV visit match
Import your Sandata or HHAeXchange visit export. Personal care, waiver nursing and home care attendant lines need a verified visit for the same day and service with the units billed.
Service plan units and program
Each service is billed within the units on the service plan, to the program that authorized it: PASSPORT, MyCare Ohio or the Ohio Home Care Waiver.
Waiver rate tables
Published PASSPORT and Home Care Waiver rates for expected versus paid without a contract upload.
Institutional (837I) claims
Medicare home health episodes billed on the institutional claim format.
How a home care claim moves
Five steps. The last decision is always a person’s.
Step 1: Upload
Claims, remittances and payer contracts land in your workspace.
Step 2: Compare
Expected versus paid on every line, with the source.
Step 3: Check the visit
Units billed against the visit record, where verification applies.
Step 4: Propose
The fix, the appeal or the records packet is drafted for you.
Step 5: Approve
A person approves. Paid lines reconcile against the next remittance.
Honest status
Available today
- Expected-versus-paid on professional (837P) claims
- Denial sorting by reason code
- Appeal letters and records packets for approval
- Authorization tracking with expiring view
- Per-payer filing clock
- Provider status on the date of service
- Medicaid billed after the primary payer
- EVV visit match for personal care, nursing and attendant services
- Service plan units and billing the authorizing program
Still to come
- Published PASSPORT and Home Care Waiver rate tables
- Institutional (837I) claims for Medicare home health
Everything marked Available works today for home care claims billed on the professional format, from the EVV visits and service plans you import. The checks follow OAC 5160-32 and 5160-44-31. Waiver rate tables and institutional claims are not built yet.
Built for Ohio home care agencies
PASSPORT and MyCare providers
Agencies serving older adults and dual-eligible members, where units, rates and authorizations all have to agree.
Ohio Home Care Waiver agencies
Providers of personal care, nursing and homemaker services under the Ohio Home Care Waiver.
Agencies that also bill DODD
Teams already using ClaimYours AI for DODD who want one place for every waiver they bill.
Questions home care agencies ask.
What works for home health today?
Expected versus paid on professional claims, denials sorted by reason, appeal letters and records packets, authorization tracking and the filing clock, each waiting for your approval.
Do you support PASSPORT, MyCare or the Ohio Home Care Waiver?
Yes, for the EVV and service plan checks on all three. Their published rate tables are not loaded yet, so expected versus paid uses your contract or your payment history.
Do you handle Medicare home health episodes?
Not yet. Medicare home health is billed on the institutional (837I) format, which is not supported today.
Can I try it with home care claims?
Yes. The home care sandbox loads synthetic claims and remittances, runs them through the engine and gives you sample 837P and 835 files to upload. No real patient information.
Do you submit claims for us?
No. Everything is staged for a person on your team to approve and submit through your own route.
Bill home care? Get on the early list.
Tell us which waivers you bill and what comes back denied. Agencies on the early list see each rule set first as it is released.
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 home care agencies actually use
Home care billing lives on waiver programs, visit records and service plans that have to agree before a claim pays.
PASSPORT
Services billed to PASSPORT are checked against the units on the service plan that authorized them.
MyCare Ohio
Each service is billed to the program that authorized it, within its units.
Ohio Home Care Waiver
Waiver services checked against the service plan and the verified visit before the claim goes out.
Sandata & HHAeXchange EVV
Personal care, waiver nursing and attendant lines need a verified visit for the same day and service, with the units billed.
Medicaid billed last
A claim that bills Medicaid as the secondary payer is held until the primary payer’s answer is on file.
837P and 835
Claims and remittances in the standard formats, with every paid line compared to your contract rate.
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.