Frequently asked questions.
Paradigm provides end-to-end Medicaid billing support to ensure accurate claims and timely payments. Paradigm streamlines Medicaid billing through advanced billing automations using AI and RPA technology to reduce errors and save time. We configure and manage agency management systems (AMS) to align with Medicaid requirements, ensure seamless EVV data transmission to state aggregators, and resolve any issues promptly. Our team handles claims submission to minimize denials, tracks and addresses denied or partially paid claims, and submits appeals when necessary. We also post payments accurately in your AMS and stay updated on state rate and policy changes to keep your agency compliant.
While the VA could authorize up to 168 hours per week, there are four other different options including 20, 36, 58, and 105 hours per week. The VA will determine which option is best suitable for you based on the level of care required.
Paradigm offers a variety of services to help home care agencies manage their interactions with third-party payers such as the VA, Medicaid, Workers' Compensation, among others. Our services include enrollment support, billing automation, authorization management, AR collections, and payer line education.
We are constantly adding features and services to help agencies streamline processes, reduce errors, and grow their businesses.
Paradigm offers technology and support solutions for home care providers who work with the VA Community Care Network, Medicaid waiver and state direct programs, and Workers’ Compensation.
If you work with a third-party payer that is not currently on our list, please let us know. We are always looking for ways to expand our offerings and provide more value to our clients.
To get started with Paradigm, simply book a call with one of our account executives. They will guide you through the process of getting started, determine which of our offerings are best for your specific needs, and provide guidance on what you can expect. Click here to book a call now.
Yes, Veterans do indeed have a choice of care providers. As it states on the VA's website: 'Veterans can either choose their preferred community provider or a VA staff member can help select one. The selected community provider must be part of the VA’s network'.
Paradigm provides a comprehensive tool that allows you to easily search for the most up-to-date reimbursement rates in your specific location using your zip code. Alternatively, you can view the VA fee schedule for 2024 from the VA website.
If you have a Community Care Network (CCN) contract your payments will come from your respective Third-Party Administrator. Providers in regions 1,2, and 3 will bill and receive payments from Optum and those in regions 4 and 5 will bill and receive payments form TriWest.
In rare cases, some providers will still need to bill the VA directly, either if they have a VCA agreement or if they already have a CCN contract but their referrals have not yet been renewed to make CCN the payer.
No, the Community Care Network program does not provide any spousal or surviving spouse benefits. However, if you are interested in such benefits, you may consider looking into the Aid and Attendance program.
To receive home care under the VACCN, the Veteran must first be enrolled in the VA Health System and usually demonstrate a need for assistance with one or more ADLs (Activities of Daily Living).
The VA can issue referrals that are valid for 30 days, 60 days, or 180 to 365 days. From Paradigms' experience most VA Medical Centers are still sending out referrals for 365 days. The number of hours allowed per week will be clearly indicated on the referral.
It's important to keep track of the expiration date and renew the authorization before it expires to ensure continued payment for services provided.
Paradigm, although not affiliated with the Department of Veterans Affairs, has connections with the VA and the VACCN, strong ties with CCN Third-Party Administrators, Optum and TriWest, as well as industry expertise working with over 2000 home care agencies.
No, there is still plenty of room for new providers to enter the market. The biggest challenge is navigating the enrollment process and developing effective referral strategies. While market saturation may vary by location, Veteran care remains a growth market with significant opportunities for new providers to succeed.
VA directly: 2-3 weeks. Optum: 1-2 Weeks. TriWest: 1-3 Weeks
