Short answer: there is no single “best” tool for every agency. The right choice depends on your state mix, payer mix, how you staff billing, and whether you want your agency management system to handle most of the work or if you prefer a specialized billing layer with real people behind it. You can still pick a clear winner for your situation by matching what Medicaid and the VA require to how each platform actually performs day to day.

Here is a practical way to think it through.

First, separate the moving parts

Medicaid and VA billing sit inside a larger workflow. Claims do not get paid because you press “submit.” They get paid when visit data is clean, authorizations are current, eligibility is confirmed, and codes and units match the rules for that program.

• Scheduling and time capture live in your AMS, for example WellSky, AlayaCare, Axxess, MatrixCare, CareTime, and others.

• EVV data comes from state systems or vendor systems like Sandata and HHAeXchange.

• Clearinghouse or claim file creation happens inside the AMS or through a third party.

• Exceptions, denials, and posting are handled by your team or an RCM partner.

When you evaluate “best software,” you are really judging how smoothly these parts connect for your exact payers.

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What Medicaid billing software needs to prove

Medicaid is state driven and plan driven. The top system in one state can struggle in another. During your evaluation, push on:

• EVV reconciliation that fits your state. Can it pull the required EVV data, match time in and out to the claim, and flag mismatches before submission?

• Waiver awareness. Does it understand your waivers, codes, modifiers, prior auth rules, visit note standards, and filing limits? Ask to see your waiver and your top two MCOs live.

• MCO routing and “plain English” rejections. Your staff needs to see the real reason a plan rejected a claim, not just a cryptic code.

• Pre-submission checks. Look for clear warnings on expired or exhausted authorizations, missing notes, wrong modifiers, and ineligible members on the date of service.

• Denial rework in the same screen. Can staff fix and resubmit without exporting files and chasing spreadsheets?

• Payment posting that ties back to each visit and invoice. Remits, take backs, and offsets should update AR correctly without manual gymnastics.

• Agility when rules change. When your state flips a file format or rule, who updates what and how fast?

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What VA billing software needs to prove

VA Community Care is its own ecosystem. The best tool keeps you aligned to the Statement of Expectations of Care (SEOC) and in sync with third party administrators.

• SEOC guardrails. Track service codes, hours, date ranges, and unit limits at the authorization level and block out-of-scope billing.

• Reauthorization tracking. Show remaining hours and end dates with early alerts, not last-minute surprises.

• Eligibility and coverage checks. A quick read on veteran coverage inside the client record saves time at scale.

• Portal awareness. Even if the platform does not log in for you, it should mirror status in a way that reduces portal toggling.

• Documentation pairing. Attaching visit notes and pulling what reviewers usually request shortens post-submission back and forth.

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Match platforms to real situations

Different agencies value different strengths. Here are some priorities.

• One AMS, one place to work. Choose the AMS with the strongest Medicaid and VA fit in your state, then add a focused billing layer where it obviously falls short. WellSky and Careswitch cover the basics for many home-based care agencies.

• Multi-state or multi-waiver with heavy EVV. Favor a platform that treats EVV reconciliation as a first-class feature, not a checkbox. Ask for a side-by-side of Sandata in one state and HHAeXchange in another.

• Software plus services. If you want RCM experts working denials and posting, look for a partner that runs billing for agencies like yours at scale and gives you transparency into status, issues, and dollars at risk.

• Lean team living inside the AMS. A light assist layer that shows payment status, flags issues, and tracks authorizations inside the AMS often has the highest return.

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Score vendors the same way

Build a simple scorecard and make every provider prove it with your data.

• Medicaid fit in your state: show a same-day sample claim from EVV through posting for your top plan.

• VA fit across the SEOC: show how the system blocks out-of-scope units and tracks expiring authorizations.

• Speed to exception: show the screen that lists what is blocking cash today, sorted by revenue at risk.

• Time to resolution: show how a biller fixes an EVV mismatch, a missing modifier, and an exhausted auth.

• Reporting for managers: show AR, aging, denial rate by reason, and revenue impact from auth issues.

• Implementation burden: list the integrations, who does what, and a realistic timeline for an agency your size.

• References: two agencies in your state, same waiver, similar payer mix.

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Common gotchas

A polished demo can hide friction. Do not sign until you have clear answers on these pitfalls.

• EVV “integration” that is just a nightly file drop. If issues surface tomorrow, you lose a day. Ask about refresh frequency and error handling.

• Generic code tables without state overrides. You will spend months patching modifiers and units.

• Denial “reports” without a workflow. A PDF of reasons is not the same as an interface where staff can fix and resubmit.

• Portal whiplash. If every “Action Needed” still means five minutes in a payer portal, you are not saving real time.

• Manual posting. Partial payments, take backs, and offsets must post cleanly or your AR visibility will suffer.

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A simple next step

Pick two Medicaid claims and one VA claim that recently gave you trouble. Ask your short list of vendors to show how their software would have prevented the problem or resolved it faster, using your data, not a canned sample. If they can do that, you may have found the “best” fit for your agency.

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