In a nutshell:

A strong RCM partner for HCBS billing should offer waiver-specific expertise, manage authorizations and EVV, support multiple payers, handle denials and payment posting, and provide transparent, performance-based pricing tailored to Medicaid complexity.

The (slightly) longer version:

Choosing the right revenue cycle management (RCM) firm is critical for HCBS waiver providers, especially since Medicaid billing involves strict rules, authorization requirements, and state-specific platforms. A good RCM firm should function as an extension of your team—not just submit claims.

HCBS RCM Vendor Evaluation Checklist

✅ Payer Experience:

Do they understand your state’s waivers, codes, modifiers, and documentation rules?

✅ End-to-End Claims Support:

Will they handle the full claims process, including eligibility checks, authorizations, submissions, denials, and payment posting?

✅ EVV + Visit Reconciliation:

Can they match visits to claims using your EVV system (e.g., Sandata, HHAeXchange)?

✅ Multi-Payer Support:

Do they work with all relevant MCOs and know each plan’s quirks?

✅ Denial Management:

Do they proactively follow up on rejections, appeals, and payer communications?

✅ Billing System Compatibility:

Can they work with your AMS, clearinghouse, or EVV platform?

✅ Transparent Pricing:

Do they charge based on collections, with no hidden fees?

✅ Audit Readiness:

Do they help you stay compliant and keep documentation organized for state or MCO audits?

✅ Communication & Reporting:

Will you receive regular AR reports, denial summaries, and real-time updates?

Pro Tip: Ask for references from other HCBS providers in your state. Medicaid billing is state-specific, and experience in your market matters more than a generic RCM brand name.

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.