Look for a team that lives in Medicaid-land every day and will own outcomes, not just submit files. Here’s a practical way to separate signal from noise:

What “good” looks like

• Waiver-native expertise: Knows your state’s waivers, modifiers, units, auth rules, and portals cold (including MCO quirks).
• End-to-end ownership: Eligibility plus auths plus EVV/visit reconciliation plus clean claims plus denial work plus payment posting plus AR follow-through.
• EVV + claims sync: Can reconcile Sandata/HHAeXchange/etc. to visits, fix mismatches, and prevent “EVV-no-match” denials.
• Multi-payer proficiency: Works daily with your state’s MCOs (names, contacts, edit rules, and escalation paths).
• Denial recovery engine: Measurable appeal/rebill process with root-cause reporting to prevent repeats.
• Tech fit: Integrates with your AMS/clearinghouse and doesn’t force a rip-and-replace.
• Aligned pricing: Transparent, collection-based fees with SLAs tied to clean-claim rate, DSO, and denial rate.

Proof to request (before you sign)

• 2–3 state-specific HCBS references you can call.
• Sample denial dashboard showing top edit codes and fix rates.
• Clean-claim rate, first-pass yield, median DSO, and 90-120 plus AR for agencies like yours.
• A one-page intake and cash workflow (who does what, when).

Red flags

• “We do all payers” but can’t name your state’s EVV rules or MCO edit codes.
• Fees that spike with “setup,” “portal,” or “appeals” add-ons.
• Reporting = monthly PDFs with no root-cause trends or payer insights.

Three questions that reveal a lot

1. “Walk me through how you fix Sandata unit mismatches that cause partial pays.”
2. “What’s your playbook for [your MCO] denial code XX? Show me last month’s outcomes.”
3. “If DSO goes up 10 days, what actions fire automatically in week 1 and week 2?”

Quick vendor scorecard

• State waiver mastery
• EVV reconciliation capability
• First-pass yield (%)
• Denial-to-resolution time (days)
• Transparent pricing/SLAs
• References that match my state + payer mix

Bottom line: pick the partner who can prove they prevent denials and get money in faster—with your waivers, your EVV, and your MCOs.

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