Illinois Medicaid Billing For Home Care and Home Health Agencies
Illinois Medicaid is administered through multiple Managed Care Organizations (MCOs) and state departments, each with its own contracting, billing, and EVV rules. Paradigm is your one-stop solution for handling it all: automating claims, preventing denials, and getting you paid faster across every MCO you work with.
Electronic Visit Verification
Illinois requires EVV for most Medicaid-funded personal care and home health aide services. Clean, timely visit data is critical—any issues in EVV can result in denied or delayed payments.
Illinois uses an open model for EVV. Agencies may choose their own EVV vendor, but it must be integrated with the state’s aggregator to submit compliant visit data.
Illinois is transitioning to HHAeXchange as their EVV Aggregator. Some services currently do not require submission of EVV data to an aggregator while others do. The DRS programs still use Sandata as their aggregator.
Claims in Illinois must be submitted to the client’s corresponding coverage, whether it be an MCO or the state directly. Claims are not currently being routed through HHAeXchange, for services where the integration is complete.
Rates
How much does Medicaid pay for home care per hour in Illinois?
Rates vary depending on waiver type and MCO but typically range between $21 and $24 per hour for personal care services. Some waivers or payers may reimburse at higher rates for specialized supports or behavioral services. Overtime and holidays are generally not reimbursed unless pre-approved in the care plan.
Payers
Illinois Medicaid is managed through a mix of state programs and MCOs, including:
- Aetna Better Health of Illinois
- Blue Cross Community Health Plans
- CountyCare Health Plan
- Meridian Health Plan
- Molina Healthcare of Illinois
- YouthCare (Centene)
Each payer has its own EVV and claims process. Paradigm centralizes and simplifies the workflow so you can focus on care, not payer admin.
MCOs
Frequently Asked Questions
A common timeframe is 60–120 days, though the exact timeframe varies by state and can be longer if applications are incomplete or require corrections.
Yes. After IMPACT approval, you must credential with each individual MCO to receive referrals, authorizations, and payment.
Illinois offers multiple waivers that support non-medical home care, including the Children and Young Adults with Developmental Disabilities - Support Waiver, Children and Young Adults with Developmental Disabilities - Residential WaiverChildren and Young Adults with Developmental Disabilities - Residential Waiver, Children and Young Adults with Developmental Disabilities - Residential Waiver, and People who are Medically Fragile, Technology Dependent. Eligibility and rates vary based on the client’s program and MCO.
Yes. Agencies must obtain a Medicaid Provider ID through IMPACT, with appropriate service codes tied to waiver eligibility. This ID is required before you can submit claims or contract with MCOs.
Credentialing typically takes 3 to 5 months, depending on the speed of IMPACT approval and how quickly MCOs respond to your contracting submissions.
You must first register with Illinois Medicaid via the IMPACT system. Once approved, you’ll need to complete credentialing with each MCO individually before you can begin billing. Paradigm supports both state and MCO enrollment steps.
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 has been a tremendous help for managing and growing my business. They are the payer gurus in this industry.”
“Prior to partnering with Paradigm, our VA billing was an ongoing stressor in the office. Working with Paradigm was the best choice we could have made.”
“We’re growing quickly. . . using Paradigm has taken a lot of work out of our hands and the customer service response time is fantastic.”
"Paradigm make the 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 two years now. They are very responsive and have EXCELLENT customer service. I highly recommend them.”
"In the past, some payments would show up 2-3 months after 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 billing. Gives me time to focus on other critical areas.”
"Paradigm handles all of our current billing; our claims are submitted timely and correct. Most importantly, we're being paid quickly and accurately for our work!"
