North Carolina Home Care Billing Resources
This page provides an overview of North Carolina programs, waivers, payers, and EVV requirements relevant to home care (non-medical) providers operating in the state of North Carolina.
Electronic Visit Verification
North Carolina Medicaid operates an Open EVV Model, which allows providers to choose their own EVV system, if the chosen vendor successfully transmits data to the state's designated aggregators (such as Sandata, HHAeXchange, or CareBridge).
Providers have the freedom to select a vendor that best aligns with their business workflow.
Sandata serves as the primary state EVV aggregator. Depending on the beneficiary's plan, agencies submit verified visit data to platforms like HHAeXchange or CareBridge.
If a provider does not wish to purchase a third-party vendor system, the state provides free EVV solutions:
- Standard Plans (UHC, Amerihealth Caritas, Carolina Complete, Alliance Health, Partners, Trillium Health Resources, Vaya Health): HHAeXchange
- Healthy Blue: CareBridge
- NC Medicaid: Sandata
Programs & Waivers
- NC Community Alternatives Program for Children (CAP/C)
- NC Community Alternatives Program for Disabled Adults (CAP/DA)
- NC Innovations Waiver
- NC Traumatic Brain Injury (TBI) Waiver
- Personal Care Services (PCS)
Payers
Payers
NC Medicaid / NC Tracks
MCOs
- UHC
- Healthy Blue
- Amerihealth Caritas
- Carolina Complete
Tailored Plans
- Alliance Health
- Partners
- Trillium Health Resources
- Vaya Health
Programs & Waivers
Payers
Frequently Asked Questions
Yes. North Carolina requires Electronic Visit Verification (EVV) for Medicaid-funded services delivered in the home. Providers must utilize an approved EVV solution that captures federally required visit data elements, including service date, caregiver, member, location of service, and time of visit. EVV compliance is required for successful Medicaid claims processing and reimbursement.
North Carolina Medicaid reimburses non-medical home care services through several programs, including Community Alternatives Program for Disabled Adults (CAP/DA), Community Alternatives Program for Children (CAP/C), Innovations Waiver services, and NC Medicaid Personal Care Services (PCS). Covered services may include personal care, in-home aide services, respite care, and other community-based supports designed to help members remain safely at home.
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.
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