For Texas Medicaid home-care agencies

Find the Medicaid revenue your agency already earned.

We match every EVV visit, authorization and remittance, then fix what is leaking: visits never billed, claims that don't match EVV, authorizations that lapsed. AI does the matching. A person approves every fix.

Built to HIPAA Security Rule requirements. Business associate agreement before any data moves. US-only storage. AI providers under BAA. A person approves every fix.

For PAS, PHC, CAS and HCS providers working with STAR+PLUS health plans. Flat monthly fees.

Where the money goes

Every lost dollar starts as a paperwork gap

Texas requires EVV for Medicaid attendant services, and health plans pay only when the visit, the authorization and the claim all agree. When they don't, the agency did the work and doesn't get paid.

Unbilled

Verified visits never billed

The visit is in EVV, but no claim went out. Common after staff turnover or system changes.

Mismatch

Claims that don't match EVV

Units, dates or service codes differ from the visit record, so the claim is denied.

Over auth

Hours beyond the authorization

Attendants deliver more hours than the plan approved. Those hours can't be paid.

Expired

Lapsed authorizations

Care continues after the authorization end date because nobody requested the renewal in time.

Deadline

Claims near the filing limit

Held or rejected claims age past the health plan's filing deadline and become unrecoverable.

State EVV

Visits the state rejected

Your EVV system says verified, but the state aggregator rejected the visit. Since January 2026 there is no grace period: the claim is denied until visit maintenance fixes it and an adjusted claim goes out.

Burn rate

Units that run out early

At the current schedule, a client uses up the authorized units weeks before the authorization ends. The hours after that can't be paid.

Payroll

Pay that doesn't match the visits

Caregivers paid for days with no EVV visit, visits never paid, missed overtime, and a direct-care share below the coming 80% federal rule.

Live demo · synthetic data only

Revenue Leak Finder

This shows the analysis a Revenue Leak Audit delivers, run on a fictional agency with generated records. Pick an agency size, rerun the analysis, click any finding to see the drafted fix, and approve it the way your biller would.

Bluebonnet Home Care Fictional 120 Medicaid clients · 90 days of EVV, claims, remittances and authorizations
Revenue at risk (90 days)—
Verified visits not billed—
Denied claims to fix—
Authorizations ending in 30 days—renewals to request now

Revenue at risk by cause

Click a bar to filter the work queue

Authorizations ending soon

Hours used of hours authorized

Work queue

ClientService dateFindingRecommended fixAmountStatus
Drafted fixDraft · needs biller approval

              

Audit log

Every AI suggestion and human decision is recorded
Your own files? Real EVV and remittance files are analyzed only in our secure portal, after a business associate agreement is signed. Request a Revenue Leak Audit

All names, IDs, rates and amounts in this demo are generated. The demo uses an illustrative rate of $21.50 per attendant hour; your agency's rates come from your health plan contracts.

See the real output · synthetic data

Download a full sample audit

These files are the actual engine output for a fictional 120-client agency: every EVV visit, claim, payment, authorization, state EVV record and payroll line checked. Nothing here is a mock-up.

Audit report

What the owner reads
  • Money recoverable, compliance exposure and what is already lost
  • Draft corrected and adjusted claims, waiting for approval
  • Open the report · Excel workbook

EVV worklist

For the EVV coordinator
  • Every visit to fix, soonest deadline first
  • Rejection code, how to fix it, and what to do after
  • evv_worklist.csv

Authorization forecast

For the authorization coordinator
  • Units used, weekly pace, and the date units run out
  • Requests to send before the hours become unpaid
  • auth_forecast.csv

Payroll reconciliation

For payroll and the owner

How we know it works: the fictional agencies are generated with problems planted on purpose and an answer key. On every test run the engine has to find every planted problem and report nothing else, across four different agency software layouts, before a release ships.

How it works

From signed agreement to first recovered dollars in about two weeks

Sign the BAA

A business associate agreement and a fixed-fee service agreement, both in plain language, before any data moves.

Send standard exports

Your EVV visit export, 835 remittance files and authorization list. No system changes and no new software for your staff.

We match and review

Our software reconciles visits, claims and authorizations. A billing specialist checks every finding before it reaches you.

Fixes and a weekly report

Corrected claims, appeal drafts and renewal requests for your approval, plus a weekly report of dollars recovered.

Services

Start with one audit. Keep what pays for itself.

Fixed scope, flat fees, month to month. We never charge a percentage of what you bill or collect.

Start here

Revenue Leak Audit

$750 flat · credited to your first month
  • 90 days of EVV, claims, remittances and authorizations
  • Dollar amount at risk, by cause
  • Prioritized fix list delivered in one week

EVV & Claims Rescue

from $1,000 / month
  • Daily EVV exception and state-rejection worklist
  • Claims matched to verified visits
  • Denial follow-up, corrected and adjusted claims
  • Weekly recovered-revenue report

Authorization & Intake Desk

from $500 / month
  • Hours used vs. authorized, every client
  • Burn-rate forecast: units that run out early
  • Renewal requests 30 days ahead
  • Same-day handling of new referrals

Payroll & Direct-Care Check

from $400 / month
  • Every pay line matched to an EVV visit
  • Unpaid visits, pay with no visit, missed overtime
  • Direct-care share of revenue, tracked toward the 80% rule

Credentialing & Enrollment

from $500 per provider
  • TMHP enrollment and revalidation
  • Health plan credentialing
  • Deadline tracking so payment never stops

Compliance Readiness

from $2,500 setup
  • HIPAA security risk analysis
  • Policy manual and staff training
  • Monthly exclusion-list screening
  • Mock survey before your state visit

Monthly prices depend on agency size and are set in writing before work starts. Fees are for our work only and never depend on referrals, patient volume, or the amount you bill or collect.

Trust center

How we handle your data, your claims and our AI

You are trusting us with patient information and with your Medicaid revenue. Here is exactly what we do, what we never do, and which documents you can review before signing.

Last updated October 24, 2026

HIPAA Security Rule

Risk analysis, safeguards, BAAs, breach procedures

In progress
NIST Cybersecurity Framework 2.0

Our security controls mapped to its six functions

In progress
NIST AI Risk Management Framework

How we govern, test and monitor our AI

In progress
SOC 2 Type II

Independent CPA audit of our controls over time

Planned
HITRUST

Healthcare certification, when we serve health plans

Planned

No government agency certifies HIPAA compliance, and NIST does not certify companies. We show where we stand on each standard and update the status, with the date and the assessor's name, when an independent review is complete.

Security

  • Business associate agreement signed before any data is shared, and with every vendor that touches it
  • AES-256 encryption at rest and TLS 1.2 or higher in transit; multi-factor sign-in for every account
  • Least-privilege access: staff see only the clients they are working on
  • US-only data storage on HIPAA-eligible cloud services
  • Every access and change written to a tamper-evident audit log
  • Data returned or deleted when the engagement ends, with written confirmation

How we use AI

  • AI reads exports, matches records, drafts corrected claims, appeals and renewal requests
  • A billing specialist reviews every finding, and you approve every fix before it is submitted
  • Each AI suggestion is logged with its inputs, the reviewer and the decision
  • We sample-check AI results against human review every month and publish the accuracy to clients
  • AI services run under a BAA, and your data is never used to train models

What we never do

  • Change an EVV record to match a claim. Claims are corrected to match the verified visit, never the reverse
  • Submit a claim or appeal without your approval
  • Add or edit anything in a clinical or care record
  • Charge a percentage of billing or collections, or pay or accept anything for referrals
  • Contact your clients or their families

Our commitments to you

  • A designated security and privacy officer, reachable at [email protected]
  • We sign your BAA or ours, before any data is shared
  • Prompt notice of any security incident, within the timeframe in our BAA
  • Monthly screening of our own team against the OIG, SAM and Texas HHS-OIG exclusion lists
  • Background checks for anyone who handles patient information
  • Your security questionnaire completed within 5 business days
  • Flat fees only; we never pay or accept anything for referrals

Subprocessors

Every outside service that can touch your data. Each one signs a business associate agreement with us before it is used, and stores data in the United States only.

ServiceWhat it doesData locationBAA
Cloud hostingStores files and runs our matching softwareUS regions onlyProvider selection in progress
AI model providerReads exports and drafts fixes; no training on your dataUSRequired before first use
Email and documentsSecure messages and shared reportsUSRequired before first use
Secure file transferEncrypted upload of your exportsUS regions onlyRequired before first use
DocumentWhat it coversStatus
Security overviewControls listed above, in detailOn this page
AI-use policyWhat AI does, human review, logging, accuracy checksOn this page
Business associate agreementHIPAA obligations, breach notice, data returnOn request
Service agreementScope, flat fees, term, cancellationOn request
Certificate of insuranceProfessional and cyber liabilityIn preparation
Exclusion screeningMonthly OIG, SAM and Texas HHS-OIG checks of our own teamOn request
Subprocessor listEvery outside service that can touch your dataOn this page
Security questionnaire answersPre-filled answers to common healthcare vendor questionnairesIn preparation
Penetration test summaryYearly outside test of our systemsPlanned

AI proposes, a person decides, and everything is logged. That is the rule for every claim we touch.

Founding agencies

Three Texas agencies get founding terms

We are a new company, so we are offering the first three agencies a reduced rate in exchange for honest feedback while we grow.

  • Founding rate locked for 12 months
  • Revenue Leak Audit included at no charge
  • A dedicated contact on our team, with weekly check-ins
  • Your input shapes what we build next
  • In return: a case study and reference, only if the results earn it
Founding slots
OpenOpenOpen

Best fit: Texas agencies serving 50 to 300 Medicaid clients through STAR+PLUS, using an EVV system that can export visits.

Apply for a founding slot
Who you work with

Built for regulated work from day one

ClaimRudder is a Texas company that builds revenue and compliance software for Medicaid home-care agencies. Our team comes from AI, risk, governance and security work in regulated industries, and it shows in how we operate: controls first, every decision traceable, nothing automated that a person should decide.

We serve agencies across Texas, remotely or in person, and every engagement has a named contact on our team.

Questions agencies ask

Before you send us anything

Do we have to change our EVV or billing software?

No. We work from the standard exports your systems already produce: the EVV visit export, 835 remittance files and your authorization list.

Will you submit claims for us?

Only with your approval. We prepare corrected claims, appeals and renewal requests; your biller or administrator approves each one. Submission can stay with your team if you prefer.

Why flat fees instead of a percentage of collections?

Flat fees keep our incentives clean and avoid Medicaid rules on billing agents being paid a share of what is billed or collected. You know the cost up front.

What if our data is messy?

That is normal. The audit tells you exactly where the gaps are. If cleanup goes beyond the agreed scope, we quote it separately before doing it.

Is the demo real data?

No. Every name, ID and amount in the demo is generated. We never use client data in demos or marketing.

Contact

Book a 20-minute call

We will ask how your agency bills today, which EVV system you use, and where you think money is slipping. No data is shared on the first call.

Email Location

Texas · serving agencies statewide

Bring to the call

Your approximate client count, your EVV system's name, and your top two billing headaches.