Reconciliation

Catching DHS & Medicaid gaps early

The short version

Money leaks quietly — a denied claim, a short-pay, a deposit that never lands. Reconcile billed vs. paid vs. deposited every month and those gaps surface in weeks, while appeals and rebills are still on the table, instead of at audit time.

The three numbers that should agree

For every period, three figures should reconcile: what you billed, what the payer says it paid (the remittance/835), and what actually hit your bank. When they diverge, that difference is denials, short-pays, adjustments, or a missing deposit — and each one is money you either recover or lose.

Catch it while you can still fix it

Appeals and rebills run on deadlines. A denial you find during month-end close can usually be corrected and resubmitted; the same denial found a year later at audit is just lost revenue. Monthly reconciliation is the difference between recovering the money and writing it off.

It also protects you the other direction: catching an overpayment early lets you handle it on your terms, not the auditor’s.

Make it a routine, not a rescue

  • Reconcile every bank and payer account monthly — no exceptions, no “we’ll catch up later.”
  • Post remittances against the claims they pay, so partial and denied lines are obvious.
  • Track denials by reason and payer; a recurring reason is a process fix, not a one-off.
  • Keep the trail linked — claim to remittance to deposit — so nothing has to be reconstructed later.
Let NavSuccess handle itWe reconcile billed-to-paid-to-deposited every month, so denials and short-pays get caught while they’re still fixable.

NavSuccess does this for home care & healthcare agencies — see Reconciliation services.

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Common questions

How often should we reconcile?

Monthly at minimum, as part of closing the books. Weekly claim follow-up plus a monthly full reconciliation catches the most, the soonest.

What usually causes billed-vs-paid gaps?

Denials, partial payments, contractual adjustments, timing, and occasionally deposits that never posted. Categorizing the difference tells you whether to appeal, rebill, or record it.

Can old gaps still be recovered?

Sometimes — but appeal and rebill windows close. The earlier you catch a gap, the more of it you keep, which is the whole case for reconciling monthly.

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