Texas Medicaid Billing For Home Care Providers
Texas Medicaid is a high-volume market for home and community-based care, but it comes with strict EVV compliance requirements and MCO-specific billing rules. Paradigm streamlines the process—automating claims, preventing denials, and ensuring your agency gets paid on time.
Electronic Visit Verification
Texas has required EVV since 2016, in 2021 it expanded EVV to cover all personal care services and in 2024 expanded to home health. As of 2025, providers must remain compliant with hard EVV edits, meaning claims will deny if visit data does not match the state’s EVV system.
Texas uses a closed EVV model. Agencies cannot freely choose their EVV vendor—the portal is HHAeXchange. The visits must sync with the TMHP system before they are billed.
The Texas Medicaid & Healthcare Partnership (TMHP) serves as the state’s EVV aggregator. Providers may use one of the state-approved EVV vendors (currently DataLogic/Vesta or First Data/AuthentiCare) and all data must transmit to TMHP.
Claims for EVV-required services must align exactly with visit data in TMHP. If there is a mismatch between billed units and verified units, the claim will deny. This makes real-time EVV reconciliation an essential part of billing workflows for Texas agencies.
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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"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!"
