Tennessee Medicaid Billing For Home Care Agencies
Tennessee has fully implemented an open EVV model—care providers must now align EVV data with CareBridge for TennCare billing, while DDA programs continue using Therap. Paradigm remains your one‑stop solution for automating claims, preventing denials, and getting you paid on time.
Electronic Visit Verification
Tennessee has completed its transition to an open-model EVV system. Providers serving TennCare personal care now submit EVV data via CareBridge to each MCO. DDA HCBS programs still require Therap for clock-ins, clock-outs, and billing.
TennCare now requires all EVV submissions—regardless of vendor—to pass through the state-designated CareBridge aggregator. For DDA programs, Therap remains the mandated EVV platform with location and timing requirements according to federal law.
- CareBridge is the required EVV aggregator for all TennCare MCO billing. Providers must ensure their system integrates with CareBridge. Butler Snow+15CareBridge+15CareSmartz360 |+15
- Therap continues to serve as the EVV system for all Department of Disability and Aging (DDA) programs. PMB+3Tennessee State Government+3TripLog+3
All TennCare personal care claims now must align with validated EVV data submitted through CareBridge to the appropriate MCO. For DDA HCBS programs, claims are processed via Therap. Real-time EVV reconciliation remains essential for avoiding claim denials.
Rates
How much does Medicaid pay for home care per hour in Tennessee?
Reimbursement for CHOICES and Employment & Community First (ECF) CHOICES typically ranges in the low‑to‑mid $20s per hour based on 2023–2025 updates (e.g., Personal Care Visits around $23–24/hr, Attendant Care around $21/hr). Employment supports and other specialized services may reimburse at different levels. Overtime and holiday rates usually require prior authorization documented in the plan of care. Tennessee State Government
Payers
Providers of TennCare HCBS programs bill directly to the member’s MCO using CareBridge for EVV. The three TennCare MCOs are:
- Wellpoint – via CareBridge EVV
- BlueCare Tennessee – via CareBridge EVV
- UnitedHealthcare Community Plan – via CareBridge EVV
For DDA HCBS programs, providers continue to submit EVV and billing through Therap.
Rates
Payers
Frequently Asked Questions
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.
Yes. After receiving a TennCare ID, agencies must contract with each MCO they’ll bill. Waiver Consulting GroupTennessee State Government
Programs include TennCare’s CHOICES, ECF CHOICES, and DDA waivers such as Katie Beckett. These cover services like personal care, respite, community supports, and employment supports. Tennessee State Government+2Tennessee State Government+2
Yes. A valid TennCare/Medicaid ID is required before billing or contracting with MCOs.
Begin by enrolling with TennCare via the Provider Registration portal and secure your Medicaid ID. You’ll need to contract with each MCO for TennCare HCBS billing. Paradigm handles TennCare enrollment and MCO contracting for you. Tennessee State Government
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's provider coaching gave us the structure, accountability, and operational discipline to scale from startup mode into a high-growth agency adding hundreds of care hours in just a matter of months.”
Serving veterans across Cape Cod is a major part of our mission, and Paradigm has helped make that possible. Their support with VA billing and operations has given us confidence as we continue expanding services to veterans in our community.
“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.”
The coaching helped us stop reacting to the business and start running it strategically with measurable goals, consistent accountability, and clearer operational focus.
“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.”
Provider Coaching gave our team clarity, consistency, and a roadmap for growth that immediately improved accountability across the organization.
“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.”
The coaching process helped us identify operational blind spots, strengthen leadership alignment, and create repeatable processes that improved performance across the agency.
"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!"
