Question 1

What if my agency handles third-party payer billing in-house?

Accepted Answer

Yes. We complement your internal team, allowing them to focus on client-facing work while we free them from wrestling the beast that is government payer sources. We are the only pure-play revenue cycle management company for home care agencies being paid from the VA and Medicaid. Your billing team will probably report fewer headaches and a renewed zest for life within just a few weeks.

Question 2

What if we already use scheduling software that also does VA and Medicaid billing?

Accepted Answer

Yes. We’re vendor-agnostic and integrate with your AMS. Agency management systems are scheduling software systems natively and if they include billing, it’s typically an add on. They’re not billing specialists nor focused on the VA and Medicaid. We’ve put in the time and energy to understand home care billing services better than anyone; and as a result we often get called in to clean up the messes made by non-billing vendors trying to dabble in billing. If that’s you, please get in touch.

Question 3

How about if my home care agency uses a local/boutique billing company?

Accepted Answer

Yes. Even if you’re lucky enough to have one that says they know local VA or Medicaid billing, they typically don’t have the resources for rapid response times, escalated claims, and AI-powered monitoring. Paradigm’s home care revenue cycle management platform does. Our home care payer management software takes out the human error element so your agency wins.

Question 4

If we use a generic healthcare RCM company for our home care billing, are we a good fit for Paradigm?

Accepted Answer

Yes. Generic RCM companies rarely understand home care, and this often results in small mistakes, unnecessary denials, slower claim escalation, and missed revenue. In addition, most broad RCMs don’t understand the complexities of the VA and Medicaid. Paradigm is 100% focused on the nuances of billing for home care agencies.

Question 5

Can Paradigm help me get VA referrals?

Accepted Answer

Yes, but we don’t provide them directly. We guide agencies through HSRM and Ensocare setup, and coach you on how to connect with VA case managers.

Question 6

Do I need to be credentialed with the VA first?

Accepted Answer

No. We’ll handle your TriWest or Optum enrollment from start to finish.

Question 7

Which TPAs does Paradigm support?

Accepted Answer

We support both TriWest and Optum, including their different systems, processes, and billing rules.

Question 8

Can Paradigm bill the VA directly in my agency management software?

Accepted Answer

Yes. We work with AMS platforms like WellSky, AxisCare, AlayaCare, and others.

Question 9

How does Paradigm charge for VA billing services?

Accepted Answer

We operate on a pay-for-performance model - no setup fees, no monthly minimums.

Question 10

Can you help if I’m already credentialed but struggling to get paid from the VA?

Accepted Answer

Yes. We’ll take over your claims process seamlessly, fix billing issues, and ensure compliance moving forward.

Question 11

Does Paradigm provide training on VA Billing for my staff?

Accepted Answer

Yes. We offer VA billing education, compliance training, and ongoing support for your care coordinators.

Question 12

Can Paradigm help me enroll in Medicaid or with MCOs?

Accepted Answer

Yes. We manage the entire Medicaid enrollment process with state programs and contracted MCOs.

Question 13

Can Paradigm bill directly in my EVV or agency management system?

Accepted Answer

Yes. We work with AMS platforms like HHAeXchange, Sandata, WellSky, AxisCare, and more.

Question 14

What if I’m already doing Medicaid billing but it’s a mess?

Accepted Answer

We can seamlessly take over your claims process, clean up your AR, and fix systemic issues moving forward.

Question 15

Do you reconcile EVV with shifts?

Accepted Answer

Yes. We reconcile shifts, clock-ins, and visits across your EVV and AMS systems every week before claims are submitted.

Question 16

How does Paradigm charge for Medicaid billing?

Accepted Answer

We operate on a performance-based model - only charging a small fee when claims get paid.

Question 17

Can you help with both Medicaid and the VA billing?

Accepted Answer

Yes. Many of our agencies bill both, and we specialize in managing both third-party payer types side by side.

Question 18

Do you handle Medicaid claim denials and appeals?

Accepted Answer

Yes. We review, correct, and resubmit denials for Medicaid billing claims - so your team doesn’t have to.

Question 19

Do you help track Medicaid authorizations?

Accepted Answer

Yes. We flag missing or expiring Medicaid authorizations and prevent billing beyond approved limits.

Question 20

Does Paradigm provide Medicaid-specific training?

Accepted Answer

Yes. We train your team on Medicaid payer rules, shift documentation, and billing compliance.

Question 21

Do I have to use HSRM?

Accepted Answer

Most VA Medical Centers send referrals via HSRM. We can manage that process end-to-end on your behalf.

Question 22

How do I know if a shift is billable?

Accepted Answer

We match your VA billing to the referrals, ensuring the service code, hours, and date range are covered before it goes out the door.

Question 23

What if a claim is denied?

Accepted Answer

We review the reason, fix the issue, and resubmit. If needed, we work directly with the VA, TriWest, or Optum to get it resolved.

Question 24

Do you reconcile payments?

Accepted Answer

Yes, as well as payment posting. We match remits to billed shifts, flag discrepancies, and follow up on short-pays or missing payments.

Question 25

What gets VA claims rejected?

Accepted Answer

Most issues come from SEOC misalignment or timing errors. We check all of that up front to prevent denials.

Question 26

Which systems do you work with?

Accepted Answer

We’re compatible with most AMS and EVV platforms, including WellSky, HHAeXchange, and state-specific tools like Sandata.

Question 27

Do you submit through clearinghouses?

Accepted Answer

Yes. Depending on your state, we either file through a clearinghouse or directly through a state Medicaid portal.

Question 28

How do you handle denials?

Accepted Answer

We identify the cause, fix the issue, and resubmit. We also help you understand trends and prevent future denials.

Question 29

Do you match EVV and authorizations?

Accepted Answer

Absolutely. We scrub every shift to ensure it lines up with approved hours, codes, and visit data before submitting.

Question 30

How soon after service do you bill?

Accepted Answer

Most claims go out weekly, once all EVV and shift data is verified. That helps you get paid as quickly as possible.

Question 31

What happens if a VA authorization lapses without my team realizing it?

Accepted Answer

Any care delivered during this time will be unbillable. We help you avoid this issue by proactively checking authorizations.

Question 32

What if I need more hours?

Accepted Answer

We help you request an updated VA referral, with documentation support to justify the increase based on veteran needs.

Question 33

Do VA authorizations expire?

Accepted Answer

Yes, typically every 6 to 12 months. We track that timeline and initiate renewals so your agency’s care doesn’t get interrupted.

Question 34

What if I don’t have an RN?

Accepted Answer

Depending on your state, you may be mandated to use one.

Question 35

What gets home care agencies denied?

Accepted Answer

Usually it’s wrong codes, hours not justified, expired referrals, or documentation gaps. We’re here to prevent all of that.

Question 36

How often do you check eligibility?

Accepted Answer

Every week. We flag any terminations, changes in waiver status, or pending redeterminations before they affect billing.

Question 37

Do you handle prior authorizations too?

Accepted Answer

Yes. For services that require them, we submit PAs and manage renewals across all contracted MCOs.

Question 38

What if a client loses eligibility?

Accepted Answer

We notify you immediately and help determine if they can be reinstated or transferred to a different payer.

Question 39

How do you match authorizations to shifts?

Accepted Answer

We cross-check each shift against the authorized hours, codes, and timeframe-so billing is accurate and defensible.

Question 40

Can you handle different MCO rules?

Accepted Answer

Absolutely. Each MCO has its own format, timelines, and codes. We manage the complexity so you don’t have to.

Question 41

How do I know if I’m eligible for VA billing?

Accepted Answer

You’ll need a Type 2 NPI, in-home care listed under your taxonomy, a current state license, and liability insurance. We’ll validate it all upfront.

Question 42

Do you help with both Optum and TriWest?

Accepted Answer

Yes. We determine your VA region and handle contracting through the right administrator.

Question 43

What documents do I need to provide to the VA?

Accepted Answer

We’ll walk you through it, but most agencies submit a W-9, license, insurance cert, NPI confirmation, and a list of services.

Question 44

How long does it take to get approval from the VA?

Accepted Answer

VA approval usually takes 4 to 8 weeks, but that can vary by region. We actively follow up to keep things moving.

Question 45

What if my market is “closed”?

Accepted Answer

We verify this directly and can help you target adjacent counties, underserved facilities, or alternate VA referral paths.

Question 46

Do you support my state?

Accepted Answer

We currently support home care Medicaid enrollment in over 25 states. If yours is on our list, we manage all state and MCO steps.

Question 47

What’s included in the enrollment fee?

Accepted Answer

State-level application, waiver program setup, MCO credentialing, CAQH help, and document management. One flat rate.

Question 48

What if I already started the process?

Accepted Answer

No problem. We’ll audit what you’ve submitted, fix any gaps, and take it across the finish line.

Question 49

How long does Medicaid enrollment take?

Accepted Answer

Some states finish in 4 to 6 weeks. Others can take several months, especially if MCOs or waiver approvals are involved. We’ll give you a realistic timeline up front.

Question 50

Which waivers or MCOs will I need?

Accepted Answer

We help you align your services to specific programs and contract with the payers that control those authorizations.

Question 51

How do I see what’s been paid?

Accepted Answer

We track payments and reconcile them to the original shifts, so you see exactly what’s been billed and collected.

Question 52

Can I track home care billing by client or authorization?

Accepted Answer

Yes. You can filter revenue by client, service code, and date range-down to the visit level.

Question 53

Do you show when I’m underutilizing hours?

Accepted Answer

Absolutely. We track how many authorized hours have been used and flag clients at risk of losing hours due to inactivity.

Question 54

What if something gets denied by the VA?

Accepted Answer

You’ll see the denial reason, what was submitted, and what needs to be fixed. We also track resolution status in real time.

Question 55

Can this replace my VA billing spreadsheet?

Accepted Answer

Absolutely. Plus, this information is updated in real-time and provides much more detail than a basic spreadsheet.

Question 56

Do you track claims across all MCOs?

Accepted Answer

Yes. We give you claim-level visibility regardless of which MCO or state portal was used, and break it down by status and amount.

Question 57

Can I see what’s pending vs. paid?

Accepted Answer

Of course. We show what’s submitted, what’s processed, and what’s outstanding, plus any claims held up by EVV, auths, or denials.

Question 58

Do I have to reconcile payments manually?

Accepted Answer

No. We can handle payment posting and match payments to the billed shifts so you can view collections cleanly in one place.

Question 59

Will this show clients with expiring authorizations?

Accepted Answer

Yes. We track authorization end dates and notify you before they expire so you can renew in time.

Question 60

Is reporting customizable?

Accepted Answer

Fully. Export data filtered by client, date, payer, denial code, or claim status, and get clean summaries or raw data as needed.

Question 61

How do I bill the VA for home care?

Accepted Answer

You bill the VA through its Community Care Network. You need a signed referral and Standardized Episode of Care from the VA medical centre, a contract with the third-party administrator for your region - TriWest or Optum - and a Type 2 NPI. Claims go to the administrator, not the VA directly.

Question 62

What is a SEOC in VA community care?

Accepted Answer

A SEOC - Standardized Episode of Care - is the VA authorization that defines exactly what care you may deliver and bill: the approved services, the number of hours, the rate, and the date range. Anything delivered outside those four limits is generally not billable, even if the veteran needed it.

Question 63

TriWest or Optum - which VA administrator do I contract with?

Accepted Answer

It depends on your region, not your preference. The VA Community Care Network is split into regions, each administered by either TriWest Healthcare Alliance or Optum. You contract with whichever administers the region your agency serves, and you submit claims to that administrator.

Question 64

How long does the VA take to pay home care claims?

Accepted Answer

Clean claims submitted to a VA third-party administrator are typically paid within a few weeks. Agencies reporting 60–90 day waits are usually seeing the cost of rework, not administrator processing time - denied claims restart the clock, and every correction cycle adds weeks.

Every question we get asked, in one place.

Fit and getting started

Enrollment and credentialing

Billing and claims

Authorizations and eligibility

Software, AMS and EVV

Reporting and visibility

Pricing and fees

Referrals and training

Ask us the one that isn't here.

Every question we get asked, in one place.

What if my agency handles third-party payer billing in-house? Both

What if we already use scheduling software that also does VA and Medicaid billing? Both

How about if my home care agency uses a local/boutique billing company? Both

If we use a generic healthcare RCM company for our home care billing, are we a good fit for Paradigm? Both

Which TPAs does Paradigm support? VA

Can you help if I’m already credentialed but struggling to get paid from the VA? VA

What if I’m already doing Medicaid billing but it’s a mess? Medicaid

Can you help with both Medicaid and the VA billing? Medicaid

Do I need a Type 2 NPI to bill the VA or Medicaid? Both

Do I need to be credentialed with the VA first? VA

Can Paradigm help me enroll in Medicaid or with MCOs? Medicaid

How do I know if I’m eligible for VA billing? VA

Do you help with both Optum and TriWest? VA

What documents do I need to provide to the VA? VA

How long does it take to get approval from the VA? VA

What if my market is “closed”? VA

Do you support my state? Medicaid

What’s included in the enrollment fee? Medicaid

What if I already started the process? Medicaid

How long does Medicaid enrollment take? Medicaid

Which waivers or MCOs will I need? Medicaid

Do you handle Medicaid claim denials and appeals? Medicaid

How do I know if a shift is billable? VA

What if a claim is denied? VA

Do you reconcile payments? VA

What gets VA claims rejected? VA

How do you handle denials? Medicaid

How soon after service do you bill? Medicaid

How do I bill the VA for home care? VA

What is a SEOC in VA community care? VA

TriWest or Optum - which VA administrator do I contract with? VA

How long does the VA take to pay home care claims? VA

How do I bill Medicaid for home care? Medicaid

What is EVV and why do my claims fail because of it? Medicaid

What is a Medicaid HCBS waiver? Medicaid

Why do home care claims get denied? Both

What does outsourced home care billing cost? Both

What is timely filing, and what happens if I miss it? Both

How does Medicaid home care billing differ by state? Medicaid

Do you help track Medicaid authorizations? Medicaid

What happens if a VA authorization lapses without my team realizing it? VA

What if I need more hours? VA

Do VA authorizations expire? VA

What if I don’t have an RN? VA

What gets home care agencies denied? VA

How often do you check eligibility? Medicaid

Do you handle prior authorizations too? Medicaid

What if a client loses eligibility? Medicaid

How do you match authorizations to shifts? Medicaid

Can you handle different MCO rules? Medicaid

Can Paradigm bill the VA directly in my agency management software? VA

Can Paradigm bill directly in my EVV or agency management system? Medicaid

Do you reconcile EVV with shifts? Medicaid

Do I have to use HSRM? VA

Which systems do you work with? Medicaid

Do you submit through clearinghouses? Medicaid

Do you match EVV and authorizations? Medicaid

How do I see what’s been paid? VA

Can I track home care billing by client or authorization? VA

Do you show when I’m underutilizing hours? VA

What if something gets denied by the VA? VA

Can this replace my VA billing spreadsheet? VA

Do you track claims across all MCOs? Medicaid

Can I see what’s pending vs. paid? Medicaid

Do I have to reconcile payments manually? Medicaid

Will this show clients with expiring authorizations? Medicaid

Is reporting customizable? Medicaid

How does Paradigm charge for VA billing services? VA

How does Paradigm charge for Medicaid billing? Medicaid

Can Paradigm help me get VA referrals? VA

Does Paradigm provide training on VA Billing for my staff? VA

Does Paradigm provide Medicaid-specific training? Medicaid

Ask us the one that isn't here.