Indiana Medicaid Billing for Home Care Providers
Indiana’s Medicaid system offers some of the nation’s highest reimbursement rates for home care, but recent changes have created new operational challenges. Paradigm is your one-stop solution for navigating Indiana’s complex billing environment: automating claims, preventing denials, and getting you paid on time.
Electronic Visit Verification
Indiana 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.
Sandata
Open Model
Programs & Waivers
Division of Medicaid Policy & Planning
- Indiana Pathways for Aging Waiver
Division of Disability & Rehabilitative Services (DDRS)
- Health and Wellness Waiver
- Traumatic Brain Injury (TBI) Waiver
- Community Integration and Habilitation (CIH) Waiver
- Family Supports Waiver (FSW)
Payers
Pathway for Aging Payer
- Anthem Blue Cross & Blue Shield
- Humana Healthy Horizons
- UnitedHealthcare Community Plan
Programs & Waivers
Division of Medicaid Policy & Planning
- Indiana Pathways for Aging Waiver
Division of Disability & Rehabilitative Services (DDRS)
- Health and Wellness Waiver
- Traumatic Brain Injury (TBI) Waiver
- Community Integration and Habilitation (CIH) Waiver
Family Supports Waiver (FSW)
Payers
Healthy Indiana Plan (Low-income adults 19-64 who are not disabled or on Medicare)
- Anthem Blue Cross & Blue Shield
- CareSource
- Managed Health Services (MHS)
Hoosier Healthwise (Children < or = 19 and pregnant individuals)
- Anthem
- CareSource
- MHS
Hosier Care Connect (People blind, disabled or aged < 60 and not on Medicare; also foster/ward children)
- Anthem
- MHS
- UnitedHealthcare (UHC)
Pathways for Aging Payers
- Anthem
- Humana Healthy Horizons
- United Healthcare Community Plan
MyCare Ohio NextGen Dual Eligible Plans
- Buckeye Health Plan (Centene)
- CareSource Ohio
- Molina HealthCare of Ohio
- Anthem
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.
EVV is required for personal care and home health services billed to Medicaid. Claims for these services will deny if the corresponding EVV data is incomplete, inaccurate, or missing in Sandata at the time of adjudication.
Indiana uses an Open Vendor Model for Electronic Visit Verification (EVV). Agencies can either use the state-sponsored Sandata system at no cost or another EVV vendor that is integrated with the Sandata aggregator. All EVV-covered visits must be sent to Sandata for claims to be paid.
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.
“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.”
“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.”
“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.”
"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!"
