Sandata and the six facts that get homecare paid

A caregiver helps someone into a cardigan. The act is small, the relationship intimate, the work real. Now consider a different question: what record will that visit leave behind? Somewhere beyond the living room, an agency must reconcile hours, a payer must assess a claim, and a state must account for Medicaid services. The cardigan does not come with a receipt.

Sandata works in that distance between doing the work and documenting it. Its software captures visits, organizes agency operations and helps move records toward billing. It is an oddly revealing business: a system built around the proposition that care can happen perfectly well while its administrative evidence goes awry.

The visit and its paper twin

Sandata dates its beginning to 1978 and its pioneering electronic visit verification work to 1994. Founder Bert E. Brodsky built a company whose subject was already demanding: healthcare work distributed across homes, rather than conveniently gathered behind one reception desk. The company’s public history places EVV at the center of that development.

Then the rules caught up with the technology. The 21st Century Cures Act required states to implement EVV for Medicaid personal care and home health services requiring an in-home visit. Federal deadlines distinguished personal care from home health. A category of software that could help an agency supervise a dispersed workforce became part of a nationwide compliance obligation.

That change helps explain Sandata’s market position. It sells into a world where a caregiver, an agency administrator, a managed care organization and a Medicaid program all need something different from the same visit. The caregiver needs to record it. The agency needs to manage it. The payer needs to connect it to a claim. The state needs oversight. The software has to carry the record across those boundaries.

Six facts, many ways to lose one

The federal minimum is surprisingly compact. An EVV record identifies the service, its recipient, its date, its location, its caregiver, and its beginning and ending times. Six elements. Enough to establish the outline of a visit; hardly enough to describe everything that happened inside it.

The interesting difficulties appear when the record is imperfect. Sandata’s EVV Enhanced instructions explicitly describe visit maintenance, including adding a missed out-call or a task. Administrators can filter records and inspect the client, caregiver, date, times and services. The existence of that workflow says something useful: capturing the visit and reviewing its evidence are separate jobs.

For caregivers, Sandata Mobile Connect offers schedules, directions, tasks, observations and notes. It also supports offline use and switching between agencies. These are practical concessions to a workplace that moves. The app’s job is to meet that movement with usable documentation, rather than assume every shift happens beside a reliable office connection.

Verification has a limit worth keeping in view. A complete record can establish the specified facts of attendance and service. It cannot, by itself, measure whether a conversation was patient or a person felt respected. Those judgments require other evidence. Treating the timestamp as the whole encounter would give a very small witness a very large speaking part.

The useful art of letting rivals in

Sandata’s more distinctive choice is its open model. An agency can, where the program permits, use another vendor’s EVV system and send the resulting data to Sandata’s aggregator. The company can therefore occupy the middle of the process without supplying every tool at its edges.

Wisconsin makes the arrangement tangible. Its alternate vendors must integrate with the Sandata aggregator. Providers review whether their visit information arrived and reached the required status; the aggregator feeds records to the state’s downstream process. The department cautions that a visit marked verified by an alternate system may still fail to qualify as verified in the aggregator.

This is a useful competitive distinction, rather than a claim that every rival is closed. Sandata competes on both agency workflows and payer infrastructure. CareBridge is another name in Medicaid EVV; North Carolina’s 2023 guidance listed different solutions for different payer groups. A buyer’s actual choice depends on the program and its integration rules. A handsome interface is only one part of the comparison.

An office built around the visit

The agency products extend the record into day-to-day management. Scheduling, payroll, billing and point-of-care documentation sit alongside EVV. For intellectual and developmental disability agencies, Sandata describes program planning, care notes and incident tracking. These features address work that a basic clock-in system leaves to the office.

Fuse Agency Management brought the usability question forward: in-app guidance, troubleshooting prompts and a billing module for multi-payer claims submission. At launch, CTO Raj Bhavsar said, “We created a solution that intuitively aligns with the needs of agency staff.” The product’s premise is sensible. Every avoidable detour in a workflow gives a busy office another opportunity to enter something twice.

“We created a solution that intuitively aligns with the needs of agency staff.”Raj Bhavsar / Sandata CTO at Fuse’s launch

Sandata also sells revenue cycle management services: checking authorizations, resolving rejections, posting payments, reconciling receipts and pursuing aging receivables. That adds people and process to software. In a published testimonial, Family Home Care and Care at Home CFO Jeffrey Maynard describes the team as responsive and aggressive in collecting unpaid claims. It is a customer’s account, rather than a universal performance guarantee.

Analytics supplies another view of the same operation. Sandata’s business intelligence modules compare scheduled and actual activity, billed and EVV data, and staffing trends. Its fraud, waste and abuse tools flag overlapping services, authorization variances and location discrepancies. A flag invites examination; it should not be confused with a finding of wrongdoing.

Free depends on who signs the contract

The business model is business and government purchasing, with agency software and operational services alongside state EVV contracts. That makes “How much does it cost?” a question about eligibility and contracting before it becomes a question about features.

Wisconsin provides Sandata’s EVV data collection functionality free to providers and program payers. Providers selecting an alternate system assume its implementation and training costs. Wisconsin’s certification checklist describes a streamlined route for already certified systems and a longer route for new certification. Its current guidance tells agencies to plan for setup that may take up to three months.

The practical lesson is to include integration, training and record review in the buying decision. A provider can pay nothing for eligible state-supplied capture and still need to organize staff around it. An agency buying a different product needs to establish that its preferred workflow can produce records the payer will accept. These are different costs, even when only one appears on the software invoice.

The company inside the company

HHAeXchange announced the acquisition on October 3, 2024. Its CEO’s accompanying account reported Sandata’s 23 state Medicaid EVV contracts and more than 20,000 agencies using its technology. The transaction put that network inside a parent already acquiring other homecare software businesses. The stated rationale emphasized more support for providers and caregivers, and greater innovation with states and health plans.

For users, ownership and product migration are different events. The acquisition FAQ initially said customers would continue using their software. Later, Illinois’s 2026 implementation FAQs explained a particular transition: users of the free Sandata solution would move to the free HHAeXchange state solution, while paid Sandata users could continue as third-party EVV users. The distinction is precise, and consequential. Program instructions deserve a closer reading than an acquisition headline.

Test the awkward visit

There is a lesson here that another software buyer can copy. Ask for a demonstration of an imperfect visit. What happens when someone misses the clock-out? Who fixes it? Does the alternate vendor’s record arrive? Which status does the aggregator assign? Can the office follow that record into its billing work? Sandata’s documentation and state requirements make these questions much more revealing than a tour of the dashboard.

The approach works when an agency’s services, capture methods and integrations fit its program’s rules, and staff can maintain the records. It becomes less useful when a buyer expects attendance data to prove care quality, or expects an integration to work before testing and certification. The visit begins with a person at the door. Getting its evidence through the office requires a different kind of attentiveness.