How do I bill Medicaid as a home care agency?

Short answer
You need to enroll with your state Medicaid program, get your Medicaid provider ID, contract with the right managed care plans, set up EVV and billing, and submit authorized claims with the correct codes.

What the setup usually involves

1. Enroll with your state Medicaid program
   Create an account in the state portal, submit your NPI, EIN, licenses, insurance, and any waiver credentials. Complete any required background checks and provider agreements.
2. Get your Medicaid provider ID
   After approval, the state issues a Medicaid ID or LPI. Make sure your taxonomy and service types match the waivers and services you plan to deliver.
3. Contract with managed care plans
   If your state uses managed care, you will need separate agreements with each MCO you plan to bill. Each plan has its own forms, credentialing steps, and billing rules.
4. Set up EVV and billing
   Use the state’s required EVV system or a compliant one that integrates with the state aggregator. Confirm your AMS or billing partner can produce clean 837 files and handle remits.
5. Bill only after services are authorized
   Confirm care plans and authorizations are active. Use the correct HCPCS codes and required modifiers, and submit claims electronically within the filing window.

Common snags to avoid

• Being Medicaid approved but not yet contracted with MCOs
• Delivering care before the authorization is live
• EVV data that does not match the claim
• Missing modifiers or using the wrong code
• Filing after the plan’s deadline

Pro tip
Track authorizations and expirations like you track payroll. Most denials come from missing or exhausted hours, lapsed dates, or code mismatches.

If you would rather not build all of this in house, Paradigm can handle the end to end setup and billing for you, from state enrollment and MCO contracting to EVV configuration, claim submission, posting, and denial follow up, so you get paid correctly and on time.

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