Coverage & eligibility
Knowledge, operational application, exception recognition and accountable follow-through.
Standards & Methodology
A standard built around how revenue actually moves.
HCRI treats Medicaid revenue as a connected operational system. Competence is measured by the ability to understand dependencies, prevent failure and resolve exceptions—not by memorizing isolated billing steps.
01 — Competency Framework
Six domains of Medicaid revenue competence.
Authorization control
Knowledge, operational application, exception recognition and accountable follow-through.
Scheduling, documentation & EVV
Knowledge, operational application, exception recognition and accountable follow-through.
Claim creation & submission
Knowledge, operational application, exception recognition and accountable follow-through.
Remittance, denials & recovery
Knowledge, operational application, exception recognition and accountable follow-through.
Reconciliation, controls & leadership
Knowledge, operational application, exception recognition and accountable follow-through.
02 — Methodology
Learn the rule. Apply the rule. Defend the outcome.
Instruction begins with the revenue principle, places it inside the agency workflow and then tests the learner through realistic decisions and scenarios.
- Understand the dependency
- Recognize the failure signal
- Trace the root cause
- Choose the corrective action
- Build the preventive control
Professional standard
Submission is an activity. Reconciled revenue is the outcome.
The HCRI standard asks one question throughout the cycle: did every authorized, delivered and compliant unit of care become accurately paid and reconciled revenue?
See how HCRS assesses competence →