ALW billing, from authorization to the mailed claim.
If your RCFE participates in California's Medi-Cal Assisted Living Waiver, DHCS pays a daily rate per waiver resident — and somebody at your home counts the days and hand-fills a paper UB-04 every month. CareMAR turns that into a tracked workflow inside the resident's chart: authorized tier, service days, a previewed claim, and a UB-04 that prints in register on the real red form.
Record the authorization
Enter the tier the resident's Care Coordination Agency authorized, who authorized it, and the dates it runs. CareMAR shows you what that tier bills as before you save it — and if the resident is re-assessed mid-month, the two spans become two service lines on one claim, not two claims.
Let the service days fill themselves in
The presence calendar derives each day from the sign-outs your caregivers already record, so a normal month fills itself and staff only correct the exceptions — a hospital stay, a night at a daughter's house. A classification an administrator sets by hand is permanent; re-running the derivation can never overwrite it.
Preview the month before you commit
Pick a service month and see the arithmetic first: billable days, non-billable days, anything undocumented, and days that fall outside an authorization — with the per-tier segments and totals. Nothing is created until you say so.
Print the UB-04 and mail it
Push the computed segments onto the resident's UB-04, print it onto the real red CMS-1450, and print a matching #10 envelope addressed to the California MMIS Fiscal Intermediary. Then track the claim from draft through submitted to paid or denied.
What CareMAR will not do
Two decisions in this module exist to keep you out of a recoupment conversation. They are worth knowing before you buy.
It never picks the tier
The tier is authorized externally, by your Care Coordination Agency, off an RN-administered assessment. CareMAR records exactly what was authorized and bills exactly that. Nothing in the module computes, infers, or suggests a tier — the published DHCS rate table is used as a lookup and nothing else.
It counts conservatively on absences
The presence log records what happened on a day; whether that day may be billed is a separate rule. Today only a documented day in the facility counts, because DHCS has not confirmed how the waiver treats hospital, skilled-nursing, and home-visit days. Under-billing can be corrected by rebilling; over-billing a government payer means recoupment and an audit finding. Every claim stores the rule version it was computed under, so a denial six months from now is still answerable.
The five ALW tiers
Claims bill HCPCS T2031 with a tier modifier, one claim per resident per service month, units = billable service days. Rates below are the DHCS-published daily rates effective January 1, 2026; CareMAR links to the live DHCS rate sheet from the billing tab so you can check the current figures before you bill.
| Tier | Bills as | Per day | Acuity |
|---|---|---|---|
| Tier 1 | T2031 U1 | $95.69 | Largely independent — minimal help with daily activities |
| Tier 2 | T2031 U2 | $114.33 | Light hands-on assistance with some activities of daily living |
| Tier 3 | T2031 U3 | $132.97 | Moderate care — regular help with multiple activities of daily living |
| Tier 4 | T2031 U4 | $179.58 | Extensive assistance, which may include behavioral support |
| Tier 5 | T2031 U5 | $270.80 | Highest acuity the waiver covers |
Source: DHCS Assisted Living Waiver program page. Verify the current sheet before billing — rates are typically republished each January 1.
The UB-04 actually lands on the form
Calibrate once, print in register forever
The UB-04 is a preprinted red form with roughly 430 boxes, and most office printers quietly scale the page — which looks exactly like bad coordinates. CareMAR prints an alignment sheet with a 100 mm ruler on it. You measure the ruler with an actual ruler, type what you measured, and CareMAR corrects for your printer's scaling. Nudge controls handle the rest, and the screen warns you when a saved nudge is too large to be real calibration.
Every service line prices at its own tier
A mid-month re-assessment produces one claim with a service line per tier span, and each line is priced from its own tier's rate — not the first span's rate applied to all of them.
Around the claim
- Individual Service Plan. Record the CCA-issued ISP — effective dates, review-due reminder, authorized services with their HCPCS codes and units — and log delivery day by day. T2031 is a bundled daily rate, so the ISP is audit evidence for the care behind the rate, not an input to the claim.
- Room and board stays separate. Medi-Cal covers the waiver services; room and board is still billed to the resident. Those statements live in their own tab, and a resident who converts mid-year keeps each era's statements where they were issued — see resident statements.
- Everything else is unchanged. A waiver resident is still a resident: same MAR, same vitals, same LIC forms and Title 22 obligations. What splits at the payer line is billing and paperwork, not the chart.
- Paper claims, on purpose. CareMAR generates and tracks the paper UB-04 and its envelope. It does not submit claims electronically, and it is not a clearinghouse.
What it costs
ALW billing is included in every CareMAR plan — it is not a separate add-on, and there is no per-resident fee for waiver residents. A home with two waiver residents pays exactly what a home with none pays: its plan, and nothing on top.
Plans and trial terms are on the pricing section. General subscription, cancellation, and refund terms are in the billing policy.