Colorado Home Care Billing Resources
This page provides an overview of Colorado programs, waivers, payers, and EVV requirements relevant to home care (non-medical) providers operating in the state of Colorado.
Electronic Visit Verification
Colorado uses a hybrid EVV model. Provider agencies can use the free State EVV Solution (via Sandata) or contract with an approved third-party vendor (Provider Choice).
- Colorado’s aggregator is Sandata and the model type is hybrid (Provider Choice).
- No hard EVV edits are in use.
Providers choose to use either the state-provided tool or a certified alternate EVV system that submits data to Sandata.
- Claims submitted for EVV-applicable services are verified against recorded visit data.
- Missing or mismatched visit data can result in audits and recoupments.
Programs & Waivers
Community First Choice Option
Community First Choice (CFC) is an optional Medicaid program that allows states to offer select home and community based attendant services and supports to eligible members on the State Plan, expanding long-term care services to more Health First Colorado (Colorado's Medicaid Program) members.
Members have the option to self-direct their attendant care services or to receive services through an agency. CFC gives members access to service delivery models that allow them to control their own budget, select and dismiss their attendants, and provide training for the people who provide their care.
Payers
Health First Colorado
Programs & Waivers
Payers
Frequently Asked Questions
Yes. Colorado requires Electronic Visit Verification (EVV) for Medicaid-funded personal care and home health services provided in the home, in accordance with the federal 21st Century Cures Act. Providers must use an approved EVV solution that captures required visit information, including the date, time, location, caregiver, and type of service provided. Accurate EVV documentation is required to support Medicaid claims and reduce the risk of claim denials or payment delays.
Colorado Medicaid covers non-medical home care services through several Home and Community-Based Services (HCBS) waivers, including the Elderly, Blind and Disabled (EBD) Waiver, Brain Injury (BI) Waiver, and Community Mental Health Supports (CMHS) Waiver, among others. Eligible members may receive services such as personal care, homemaker services, respite care, and other long-term supports that enable them to remain safe in their homes and communities. Services are coordinated through Colorado's regional Case Management Agencies (CMAs).
Most states operate Medicaid waiver or community-based care programs that allow reimbursement for non-skilled services such as personal care, homemaker services, respite care, and attendant care. These programs are often administered through Home and Community-Based Services (HCBS) waivers, aging programs, disability waivers, or managed long-term services and supports (MLTSS) programs. Eligibility criteria, covered services, and billing requirements vary by state.
In many states, yes. Enrolling with the state Medicaid program is typically the first step, but agencies may also need to complete separate contracts, credentialing applications, or network enrollment with individual Medicaid MCOs before claims can be submitted for reimbursement. Requirements vary by state and payer, largely depending on whether the state operates an MLTSS (Managed Long Term Services and Supports Program).
Credentialing timelines vary by state and payer, but most home care agencies can expect the Medicaid enrollment and credentialing process to take anywhere from 60 to 180 days. Delays are often caused by incomplete applications, missing ownership documentation, background check issues, or required site visits. Agencies seeking participation with Managed Care Organizations (MCOs) should also account for additional contracting and payer credentialing timelines.
How Paradigm can Help
Paradigm offers a combination of tech and highly skilled people to bridge the gaps in:
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
& Eligibility
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
Credentialling
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
Paradigm's provider coaching gave us the structure, accountability, and operational discipline to scale from startup mode into a high-growth agency adding hundreds of care hours in just a matter of months.”
Serving veterans across Cape Cod is a major part of our mission, and Paradigm has helped make that possible. Their support with VA billing and operations has given us confidence as we continue expanding services to veterans in our community.
“As the founder of a home care agency billing the VA. . . I can truly say using Paradigm is one of the best business decisions I’ve made.”
"Paradigm has been a tremendous help for managing and growing my business. They are the payer gurus in home care billing.”
The coaching helped us stop reacting to the business and start running it strategically with measurable goals, consistent accountability, and clearer operational focus.
“Prior to partnering with Paradigm, our VA billing was an ongoing stressor in the office. Working with Paradigm was the best choice our home care agency could have made.”
Provider Coaching gave our team clarity, consistency, and a roadmap for growth that immediately improved accountability across the organization.
“We’re growing quickly. . . using Paradigm has taken a lot of work out of our home care billing and the customer service response time is fantastic.”
The coaching process helped us identify operational blind spots, strengthen leadership alignment, and create repeatable processes that improved performance across the agency.
"Paradigm makes the home care billing process incredibly simple and efficient, especially when we have any type of billing issue. I don't know if I could handle our VA caseload if it wasn't for them!"
“I’ve been using Paradigm for our home care billing for two years now. They are very helpful with my VA billing and have EXCELLENT customer service. I highly recommend them.”
"In the past, some VA payments would show up 2-3 months after home care services were provided; with Paradigm in place, all VA payments arrive just a week after billing is concluded."
“Paradigm makes my life so much easier with automated home care billing. That gives me time to focus on other critical areas.”
"Paradigm handles all of our home care billing; our claims are submitted timely and correct. Most importantly, we're being paid quickly and accurately for our work!"
