Waiver billing that arrives on time, survives audits, and stops leaking.
We run Assisted Living Waiver, Residential Habilitation, and ILS billing end-to-end for assisted living and residential care communities. Claims go out electronically every week, every remittance is reconciled, and every denial is worked. Your team keeps private pay in-house. We handle the programs that pay the rest.
Nothing is "in the mail." Every claim has a receipt, and if one stalls we know where and why.
Results from inside the industry, traced to remittance records
Every figure comes from client remittance records. Recovered means paid. Pending and appealed amounts are shown separately and never added in.
One accountable partner for the whole cycle
Most waiver revenue is lost in the gaps between sending a claim, reading the payment, and following up. We own all three, so a short-paid resident is caught the week it happens.
Claims go out every week, with a receipt for each one
We build the week's claims from your census, check each one before it leaves, and send them to Medi-Cal electronically. Within hours we know every claim was received and accepted.
- ALW tiers, RH hours, and ILS cycles billed correctly the first time
- Eligibility confirmed before billing, not after a denial
- No printing, packaging, or mailing on your side
Every payment reconciled to what was billed
Medi-Cal's weekly remittance tells you what paid, what was denied, and what was taken back. We match every line to the claim behind it and turn each denial into a fix, queued for the next run.
- Short pays and duplicate denials flagged the week they appear
- Denials translated into plain-language causes and next steps
- Weekly variance report by facility, resident, and program
Missed revenue found, rebilled, and tracked until it pays
For a new client we review the last six to twelve months of remittances, remove the overlaps so nothing is counted twice, and rebill what is still inside the window. We report recovery only when the payment proves it.
- Appeals, inquiries, and chargebacks handled on your behalf
- Pending and appealed dollars tracked separately from confirmed
- Contingency pricing: a share of what actually pays
One multi-site operator, Oct 2025 – Sep 2026.
A report ownership can read in five minutes
What was billed, what paid, what is still open, by facility, resident, and program. Audit-ready documentation for CCA and DHCS reviews. And if you are not in the waiver programs yet, we guide the enrollment.
- Submission and payment tracking in one weekly summary
- Documentation that holds up when someone asks
- ALW enrollment and RH tier or hours increases, handled with your Care Coordination Agency
Denials fall, and recovered dollars are counted only once they pay
Median denied dollars per remittance
One operator's Medi-Cal remittances, before and after we took over the billing.
| Period | Median denied per remittance |
|---|---|
| Before (Oct 2025 – Mar 2026) | $9,000 |
| After (Aug – Sep 2026) | $540 |
Where the recovery dollars stand
Confirmed means paid. Everything else is reported separately until it is.
| Status | Amount |
|---|---|
| Confirmed recovered | $179,854 |
| Pending payment | $49,000 |
| Under appeal | $41,796 |
| Identified, not yet confirmed | $65,709 |
Review first. Commit once the numbers are in front of you.
Free billing review
We review your recent submissions and remittances and show you what is unbilled, denied, or recoverable, and why.
Agreement and BAA
A plain service agreement and a Business Associate Agreement. Your data stays yours.
Pilot month
We take over one cycle, run alongside your current process, and report the difference.
Weekly operations
Standing weekly runs, reconciliation, rebills, and a report you can read in five minutes.
What changed for one multi-site operator
Twelve months of remittance records, before and after we took over the billing. Every figure is traceable to a payment.
From mailed forms to electronic claims
Claims that used to leave in an envelope and go silent for weeks now come back confirmed within hours. Nothing is lost in the mail, and a problem is fixed the same day it appears.
Paid sooner, reconciled the week it posts
Every remittance is matched to what was billed as soon as it arrives. Short pays and denials are worked that week, inside the deadline, instead of surfacing at year end.
Missed revenue found, then protected
Historical gaps are identified, de-duplicated, and rebilled until they pay. The same checks then run on every new claim, so the leak that cost the money cannot reopen.
One client's results. Your facility's starting point will differ, which is what the free review is for. Read the full case study →
Find out what your last six months of remittances are hiding.
The review is free, takes about a week, and ends with a written summary of unbilled, denied, and recoverable dollars. No obligation to continue.