Medicaid

Medicaid Claims Management For Home Care Agencies

Medicaid can be one of the most reliable payers in home care, but only if your billing, authorizations, and eligibility checks are airtight. Paradigm manages the complexity so you can focus on delivering care and growing your business.

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How It Works

We only charge for successful claims, so our success depends on yours.

Expert billers and AI-powered tools

We run your Medicaid claims like we’re your in-house billing department

Human touch without human error

Our AI-powered tools scrub shifts, check authorizations weekly, and reconcile payments

We get you enrolled

We help you get enrolled with state Medicaid programs and MCOs, if you aren’t already

Don’t Risk Your Revenue

We’ve mastered the art and science of protecting your Medicaid revenue at every stage of the claims process.

Common Challenges

Unverified eligibility
Expired or missing authorizations
EVV mismatches
Incomplete or unsent claims
Medicaid-specific modifiers missing
Billing outside service limits
Backlogs in billing
Denial backlog or confusion
Delayed MCO payments
Fragmented systems

Risk to Revenue

Entire shifts denied for clients no longer covered
Denials for services delivered outside the approved range
Claims rejected due to missing or incorrect clock-ins/outs
Revenue lost on care never properly billed
Clean claims rejected over formatting or code issues
Excess units auto-denied or recouped post-payment
Aged claims risk falling outside timely filing limits
Revenue locked up while your team chases vague rejections
Weeks or months of delayed cash flow from slow payers
Disjointed data between EVV, AMS, and billing systems

Our Solution

We verify Medicaid eligibility weekly using state systems
We flag expiring authorizations and prevent unauthorized care
We reconcile EVV data with scheduled hours before submission
We track shift status and submit complete claims every week
We scrub modifiers and HCPCS codes to match each MCO’s specs
We monitor utilization and match shifts to auth limits
We submit weekly to avoid backlogs and meet payer deadlines
We work denials weekly and handle appeals when needed
We track payments by payer and follow up on slow remits
We unify data and workflows across platforms like HHAeXchange and Sandata
Solutions

We Take Care Of It All

Partnering with us will feel like you’ve gained a team of coworkers who’ve spent their whole careers mastering Medicaid.

Billing
Automation
Authorizations
& Eligibility
Enrollment &
Credentialing
Revenue
Visibility
Billing Automation

Full-service AI-powered revenue cycle management built for home care.

EVV-integrated workflows
Clean claim submission
Denial management
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Authorizations & Eligibility

Prevent denials by catching issues before they happen.

Weekly eligibility checks
Authorization monitoring
Expiration alerts and utilization tracking
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EnrolLment & Credentialing

We guide you through state and MCO enrollment so you can get started quickly.

State-specific Medicaid enrollment
MCO contracting and onboarding
Ongoing compliance and updates
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Revenue Visibility

Tools And Tracking That Give You Full Confidence In Your Medicaid Revenue Cycle

Real-time claim status
Remittance tracking
Payment reconciliation
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Expert Coaching

Grow Faster With
Expert Growth Coaching

Our revenue grows with yours, so we provide free growth coaching to our customers. Our veteran coaching team includes former agency owners, franchise trainers, sales coaches, and more.

Grow Faster With
Expert Growth Coaching.

Our growth depends on your growth. So we assembled a team of home care experts to help you out.
The coaching team includes former agency owners, franchise coaches, sales coaches, and more.

One-on-one coaching

Group training sessions

Business operation audits

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Support

Frequently Asked Questions

Can Paradigm help me enroll in Medicaid or with MCOs?
Yes. We manage the entire enrollment process with state programs and contracted MCOs.
Can Paradigm bill directly in my EVV or agency management system?
Yes. We work with platforms like HHAeXchange, Sandata, WellSky, AxisCare, and more.
What if I’m already billing Medicaid but it's a mess?
We can take over your claims process, clean up your AR, and fix systemic issues moving forward.
Do you reconcile EVV with shifts?
Yes. We reconcile shifts, clock-ins, and visits across your EVV and AMS systems every week before claims go out.
How does Paradigm charge for Medicaid billing?
We operate on a performance-based model—only charging when claims get paid.
Can you help with both Medicaid and VA?
Yes. Many of our agencies bill both, and we specialize in managing both payer types side by side.
Do you handle claim denials and appeals?
Yes. We review, correct, and resubmit denials—so your team doesn’t have to.
Do you help track authorizations?
Yes. We flag missing or expiring authorizations and prevent billing beyond approved limits.
Does Paradigm provide Medicaid-specific training?
Yes. We train your team on payer rules, shift documentation, and billing compliance.

Your bank account deserves this.

Got questions? Let’s talk.

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Solutions

Billing AutomationAuthorizations & EligibilityEnrolment & Credentialing Revenue VisibilityGrowth Coaching

Tools

VA Reimbursement ToolPayer Mix ToolMedicaid Rate Lookup Tool

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