Getting paid by the VA isn’t magic. It’s a simple rhythm you repeat every week: get set up right, match the visit to the authorization, send a clean claim, and follow it through to payment. Do that consistently and cash flow becomes predictable.

Before the first visit

Start by making sure your identity and the patient’s authorization are rock solid. Your legal name, tax ID, NPIs, taxonomy, and pay-to address should match across your W-9, contract, and the payer portal. Then check the authorization: dates, units, CPT or HCPCS, required modifiers, diagnosis, and place of service. Load those details into your software so scheduled visits line up with what was approved.

Document like payment depends on it

Because it does. For every visit, capture who, what, when, and where. If EVV applies, clear missed punches and exceptions before you bill. When the visit record, the EVV, and the authorization tell the same story, your claim is halfway home.

Quick self-check before billing

• Do the service dates and units fit inside the authorization window
• Do the codes and modifiers match the authorization and visit type
• Are EVV exceptions resolved for the units you plan to bill

Build a clean claim

Most personal care claims go out on a CMS-1500 or 837P. Small mistakes cause big delays, so standardize as much as you can. Use the member ID exactly as it appears. Put the correct billing and rendering NPIs and addresses on every claim. Align dates, units, codes, modifiers, diagnosis, and place of service to both the authorization and the visit. Attach any required notes or documents at submission. Lock this into templates so staff are selecting, not free-typing.

Don’t “submit and hope”

After you send claims, watch status daily. Respond to pended items right away. Post ERAs quickly and reconcile to the penny. Treat denials as signals. Fix the root cause so you prevent the next one, not just resubmit the same error.

Usual denial culprits

• Authorization mismatch on dates, units, or codes
• Identity errors like member ID or NPI
• EVV and billed units that don’t line up
• Missing documentation or late attachments
• Wrong place of service or small coding slips

What good looks like

Clean claims follow a steady weekly cadence. Teams review pends and denials the same week they appear. EVV and documentation exceptions get cleared before the next billing run. When those habits stick, days to payment shrink and write-offs drop.

A quick real-world fix
One agency’s cash delays came from small errors on about one in five claims. We added an authorization-to-claim checklist, surfaced EVV exceptions earlier, and tightened claim templates. Denials fell sharply and average payment time improved by almost two weeks.

Paradigm’s take

You can do all of this yourself, or just hand it to Paradigm—we’ll track renewals, compile clinical packets, coordinate with the VA/TPAs, align visits to claims, and manage escalations so your VA CCN authorizations and billing run smoothly while you focus on care.

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