In a nutshell:

To bill Medicaid, home care agencies must maintain client authorizations, EVV-verified visit records, caregiver notes, eligibility proof, and properly coded claims—ensuring all documentation aligns with waiver or MCO requirements and is ready for audit.

The (slightly) longer version:

To bill Medicaid for home care services, agencies must maintain detailed records that support each claim. These documents prove that services were authorized, delivered, and properly documented according to state and MCO requirements.

While specifics may vary depending on the state and plan, the following is generally applicable.

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Required Documentation for Medicaid Billing

Client Authorization or Plan of Care

• Must show the client is approved for services under a Medicaid waiver or managed care plan.
• Should include start/end dates, service types, and units authorized.

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Completed Visit Records

• Each shift must include caregiver name, date, start and end time, tasks performed, and client/caregiver signatures (or digital verification).
• Most states require EVV-compliant documentation for time and location tracking.

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Caregiver Notes and Daily Logs

• Must describe services provided during the visit and match the care plan.
• Some states require specific wording or task codes.

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Eligibility Verification Proof (if applicable)

• While not submitted with the claim, agencies should retain screenshots or reports showing Medicaid eligibility at time of service.

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Billing Codes and Modifiers Used

• Claims should reflect the correct HCPCS codes (e.g., S5125 for personal care) and state-specific modifiers tied to the waiver or MCO.

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Pro Tip: Keep documentation organized and audit-ready. Many denials or recoupments stem from missing visit notes or unsigned logs—even if the care was actually provided.

For agencies working with Paradigm, we ensure every claim is backed by compliant documentation and flag missing or invalid records before submission—reducing denials and protecting your revenue.

Reminder: This information is not legal advice, not a guarantee, and not a substitute for checking in with your state’s Medicaid authorities and plans directly. Read our full disclaimer here.