Indiana Medicaid Billing for Home Care Agencies
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 uses an open EVV model, allowing agencies to use either Sandata or another EVV vendor, as long as it integrates with the state system. With the move to MCEs, EVV accuracy is more important than ever for avoiding payment delays.
All home care visits billed to Medicaid must be captured in an EVV system and transmitted to the state aggregator. Agencies using a non-Sandata system must ensure their vendor can successfully transmit visit data to Sandata.
Sandata is Indiana’s official EVV aggregator. Regardless of the EVV system used, visit data must flow into Sandata before claims are processed.
In Indiana, EVV and claims submission are separate processes. Providers submit claims through the Indiana Health Coverage Programs (IHCP) portal (Gainwell) or via clearinghouse/EDI connection. For Pathways for Aging members, claims go to the member’s MCE (Anthem, Humana, or UnitedHealthcare) via the MCE’s portal or EDI.
Rates
How much does Medicaid pay for home care per hour in Indiana?
Indiana Medicaid’s reimbursement rates are among the highest in the country — for example, $34.36 per hour for Attendant Care and $36.92 per hour for Respite. Rates may vary by service type, waiver, and payer. MCEs must pay at least IHCP fee-schedule minimums and may negotiate above those amounts, so agencies should verify payer contracts.
Payers
Indiana’s home and community-based services (HCBS) are split between direct state programs and MCE-administered waivers. For non-medical home care, most agencies now work with Indiana Pathways for Aging plans.
MCEs for Pathways for Aging (60+)
- Anthem
- Humana
- UnitedHealthcare Community Plan
Other waivers (Health and Wellness, TBI, CIH, FSW) are billed directly to the state via IHCP/Gainwell.
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.
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.
"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!"
