In a nutshell:

The most common Medicaid billing errors in home care include missing or expired authorizations, mismatched EVV data, wrong billing codes or modifiers, ineligible clients, duplicate claims, and late submissions—each of which can delay or reduce reimbursement.

The (slightly) longer version:

Medicaid billing for home care is complex, especially under HCBS waiver programs and MCO plans. Even small errors can result in denials, delays, or recoupments. Understanding the most frequent mistakes helps agencies tighten internal processes and avoid revenue loss.

Top Medicaid Billing Errors in Home Care

Missing or Expired Authorizations. Claims submitted outside of approved date ranges or without a valid service authorization will be denied.

EVV Mismatches. If visit times, caregiver IDs, or service codes don’t match what’s on the claim, states will reject it—especially in closed EVV systems like Sandata or HHAeXchange.

Incorrect Billing Codes or Modifiers. Using the wrong HCPCS code (e.g., S5125 vs. T1019) or omitting required state-specific modifiers will flag the claim.

Ineligible Clients. Failing to verify Medicaid eligibility on the date of service can result in claims being unbillable—even if services were rendered.

Duplicate Submissions. Accidentally submitting the same claim more than once is a fast way to trigger audits or denials.

Late Filing. Every MCO and waiver program has its own filing window (e.g., 90 or 180 days from DOS). Miss it, and you’re out of luck.

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Pro Tip: Don’t wait until a denial shows up to investigate. Build pre-submission checks into your workflow—especially for authorization status, EVV validation, and client eligibility.

Reminder: This information is not legal advice, not a guarantee, and not a substitute for checking in with your state’s Medicaid authorities and plans directly. Read our full disclaimer here.