North Carolina Medicaid Billing For Home Care Providers
Medicaid is a high-volume market for home and community-based care, but it often comes with strict EVV compliance requirements and payer-specific billing rules. Paradigm streamlines the process—automating claims, preventing denials, and ensuring your agency gets paid on time.
Electronic Visit Verification
North Carolina uses an open model. For NC Medicaid Direct, providers must use Sandata or an Alt-EVV vendor integrated with Sandata. For Prepaid Health Plans (PHPs), most plans use HHAeXchange, but Healthy Blue requires CareBridge.
- NC Medicaid Direct: Sandata
- PHPs:
- HHAeXchange — AmeriHealth Caritas NC, Carolina Complete Health, UnitedHealthcare Community Plan of NC, WellCare of NC
- CareBridge — Healthy Blue NC
- FFS: Claims are submitted via NCTracks; EVV must match Sandata data.
- PHPs: Claims go through HHAeXchange or CareBridge.
- NCTracks applies EVV edits that can pend, reduce, or deny claims if visits don’t match.
Rates
How much does Medicaid pay for home care per hour in North Carolina?
Rates vary by program and payer.
- Fee-for-service rates are set by NC Medicaid and published in official schedules.
- Managed care rates are negotiated individually with each PHP.
For example, the 2025 FFS schedule lists T1019 (Personal Care Services) at $19.52/hour statewide; negotiated PHP rates may differ.
Payers
State Program — NC Medicaid Direct
Administered by the North Carolina Department of Health and Human Services (NCDHHS). Claims go through NCTracks, with EVV captured in Sandata.
Managed Care (Prepaid Health Plans)
North Carolina has multiple PHPs that cover home care services:
- AmeriHealth Caritas North Carolina
- Carolina Complete Health
- Healthy Blue North Carolina (CareBridge EVV)
- UnitedHealthcare Community Plan of North Carolina
- WellCare of North Carolina
- Tailored Plans of Alliance Health
- Trillium
- Vaya
MCOs
Frequently Asked Questions
Yes—if your state contracts with multiple Medicaid managed care organizations, you generally need to credential with each one individually to bill for services.
In most states, the same Medicaid provider ID is used for both state plan and waiver services, but some states may assign a separate ID or require an additional enrollment step.
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.
You must apply through your state Medicaid agency, typically by completing a provider enrollment application and submitting required documentation such as licenses, background checks, and insurance. Some states also require training or orientation specific to HCBS waivers.
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.
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