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.
MCOs
Frequently Asked Questions
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.
Credentialing and contracting typically take 60–90 days, depending on MCO processing timelines.
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.
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