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Paradigm Senior Services We simplify VA and Medicaid billing for home care providers and get them paid faster.

Indiana Medicaid Billing Alert: New Claim Denial Rules Effective October 28, 2026For effective for dates of service on o...
10/21/2026

Indiana Medicaid Billing Alert: New Claim Denial Rules Effective October 28, 2026

For effective for dates of service on or after October 28, 2026, Indiana Medicaid will deny claim details when any of the following procedure codes are billed with both modifier HQ and Place of Service (POS) code 12 – Home:
• T2033 – Residential care (Participant Assistance and Care)
• S5151 – Unskilled respite care, not hospice
• T2016 – Residential habilitation

Claims submitted with this combination will be denied with EOB code 4406. Recommended provider actions:
✅ Review billing procedures for the affected waiver services.
✅ Verify that modifiers and place-of-service codes accurately reflect where and how services were delivered.
✅Ensure modifier HQ is not used with POS code 12 for the affected services.
✅ Update claim-submission workflows to reduce preventable denials.

Indiana home care providers should take this opportunity to review their billing practices before the effective date. Accurate claim coding is essential to reducing denials and protecting reimbursement.

Paradigm helps home care agencies navigate evolving Medicaid billing requirements, manage claims, and address reimbursement challenges.

Virginia Medicaid EVV Update: New Requirements effective October 1, 2026Virginia’s Department of Medical Assistance Serv...
10/20/2026

Virginia Medicaid EVV Update: New Requirements effective October 1, 2026

Virginia’s Department of Medical Assistance Services (DMAS) has implemented updated Electronic Visit Verification (EVV) requirements for all agency-directed aides and consumer-directed personal care attendants, regardless of live-in status.

What providers, attendants, and employers need to know:

✅ EVV is required for every shift. All covered aides and attendants must use an approved EVV method to clock in at the beginning of each shift and clock out at the end.
✅ Approved methods for consumer-directed attendants include the Fiscal Employer/Agent (F/EA) mobile application or Interactive Voice Response (IVR) system. The web portal is not an approved EVV method. Shifts submitted through the web portal will be considered non-compliant.
✅ GPS must be enabled when using the mobile application. Shifts submitted without GPS enabled are considered non-compliant.

Paradigm helps home care agencies navigate changing Medicaid requirements and billing complexities. Staying informed and ensuring compliance with EVV policies can help protect reimbursement and prevent avoidable disruptions to care.

Nebraska Medicaid Announces Temporary HCBS Agency Provider Enrollment MoratoriumNebraska Medicaid has announced a tempor...
10/09/2026

Nebraska Medicaid Announces Temporary HCBS Agency Provider Enrollment Moratorium

Nebraska Medicaid has announced a temporary moratorium on the enrollment of new Home and Community-Based Services (HCBS) 1915(c) waiver agency providers, effective October 1, 2026.

The moratorium applies specifically to waivers managed by the Division of Disability and Aging, including:
• Family Support (FSW)
• Developmental Disabilities Adult Day (DDAD)
• Comprehensive Developmental Disabilities (CDD)
• Aged and Disabled (AD)
• Traumatic Brain Injury (TBI)

What Nebraska providers need to know:
🔹 New agency providers: Enrollment applications are paused for six months.
🔹 New locations: The moratorium also applies to new locations of currently enrolled agency providers.
🔹 Individual providers: The moratorium does not apply to individual providers.
🔹 Existing agencies: Currently enrolled providers that remain compliant can continue serving Medicaid beneficiaries without interruption.
🔹 Access-to-care exceptions: DHHS may grant an exception when a verified shortage of specific waiver services exists in a rural or underserved county.
🔹 Duration: The moratorium is effective as of October 1, 2026, and will remain in place for six months. DHHS may extend it in additional six-month increments if warranted.

Nebraska Medicaid says the measure is being implemented to help safeguard public funds, address provider saturation in certain geographic areas, and reduce potential fraud, waste, and abuse while maintaining beneficiary access to care.

📌 Important for Nebraska home care agencies: If your agency is considering Medicaid enrollment, expanding into a new location, or entering one of these HCBS waiver programs, this temporary moratorium could affect your plans.

Paradigm will continue monitoring Medicaid policy and provider enrollment developments that may impact Nebraska home care providers.

Rhode Island Home Care Agencies: New FIDE-SNP Solicitation Now OpenRhode Island’s Executive Office of Health and Human S...
10/08/2026

Rhode Island Home Care Agencies: New FIDE-SNP Solicitation Now Open

Rhode Island’s Executive Office of Health and Human Services (EOHHS) has issued a new solicitation for qualified vendors to administer the state’s Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Program.

The solicitation is currently open, with proposals due November 4, 2026, at 11:00 a.m. EST.

Solicitation: QLV27007040
Open Date: October 2, 2026
Proposal Deadline: November 4, 2026

While this solicitation is directed to organizations interested in administering the FIDE-SNP program, Rhode Island home care agency owners and administrators should be aware of this development as changes to the administration of services for individuals eligible for both Medicare and Medicaid can have implications for payer relationships, billing processes, authorizations, and reimbursement.

👉 Home care providers should monitor this procurement and subsequent program announcements for potential changes that could affect their operations and revenue cycle.

Paradigm helps home care agencies manage Medicaid and Veteran Affairs billing, authorizations, claims, collections, and payer requirements by combining technology with hands-on revenue cycle support.

Kansas' Community Supports Waiver Takes Effect Oct. 1Kansas has received approval from the Centers for Medicare & Medica...
10/07/2026

Kansas' Community Supports Waiver Takes Effect Oct. 1

Kansas has received approval from the Centers for Medicare & Medicaid Services (CMS) for its new Community Supports Waiver, expanding access to Home and Community-Based Services for Kansans age 5 and older with intellectual and/or developmental disabilities (I/DD).

Effective October 1, 2026, the new 1915(c) waiver will provide more flexible, person-centered supports for individuals who do not require 24-hour care but need services provided in an Intermediate Care Facility for Individuals with I/DD.

For Kansas home care providers, the waiver includes several services that may create new opportunities, including:
• Personal Care Services
• Respite Care
• Non-Medical Transportation

CMS projects enrollment of 500 individuals during the first waiver year. Services are subject to an annual cap of $20,000 per participant.

Kansas home care agencies should monitor implementation guidance and provider enrollment requirements as this new Medicaid opportunity develops.

Paradigm helps home care agencies manage Medicaid and Veteran Affairs billing, authorizations, claims, collections, and payer requirements by combining technology with hands-on revenue cycle support.

Your caregiver clocks out 250 feet from the client's home.With most software, you find out three weeks later when Medica...
10/05/2026

Your caregiver clocks out 250 feet from the client's home.

With most software, you find out three weeks later when Medicaid rejects the claim.

With Paradigm, the shift gets flagged before it's ever billed.

That's what happens when AI runs your operations instead of just watching them. Scheduling, compliance, billing, and bookkeeping all work together - so the rules you set once get enforced automatically, on every shift.

No audits. No rejected claims. No scrambling to fix what already happened.

Plus, we handle your RCM - Medicaid, VA, and more - with a dedicated account manager you can actually reach.

One system. One partner. Problems solved before they cost you.

Find out more by booking a consultation: https://hubs.la/Q04ythXg0

Utah Medicaid Providers: Important HCBS Billing ChangeThe Utah Department of Health and Human Services (DHHS) is discont...
10/01/2026

Utah Medicaid Providers: Important HCBS Billing Change

The Utah Department of Health and Human Services (DHHS) is discontinuing span billing for several Medicaid Home and Community-Based Services (HCBS) programs, including the Aging Waiver.

What providers need to know:
📌 Each date of service must be billed separately. Providers can no longer group multiple service dates into a single span.
📌 Claims must reflect the exact date that services were provided. Individual check-ins, personal care visits, companion services, and other applicable units must correspond to the specific calendar date of service.
📌 Incorrect span billing may result in claim denials. The change aligns with claim validation requirements in Utah's PRISM Medicaid Provider Portal.

If your agency provides services through Utah Medicaid HCBS programs, now is the time to review your billing workflows and make sure your claims are formatted correctly.

Paradigm helps home care agencies manage claims, authorizations, collections, and changing payer requirements so your team can focus on delivering care.

HCAOA 2026 is officially in the books. 🎉We spent three days in Orlando with home care leaders who are doing the real wor...
09/30/2026

HCAOA 2026 is officially in the books. 🎉

We spent three days in Orlando with home care leaders who are doing the real work - making home care accessible, building agencies, and figuring out how to make VA and Medicaid billing actually work for their business.

Amber led a session on the VA & Medicaid compliance "double-play", and the turnout was standing room only - it's clear that agency owners are looking for practical ways to turn government payer challenges into real growth.

Outside the sessions, we hosted an Industry VIP Dinner, brought tequila tasting to the Monday night reception, sponsored the Caregiver of the Year Award, and hosted the nominated caregivers for an evening to honor their hard work.

Honestly, those informal times - the conversations over dinner, the networking between sessions - that's where some of the best moments happen.

Thanks to HCAOA for putting on a conference that truly brings the home care community together. We'll see you next year!

Home Care Association of America

We're still celebrating this incredible news from HCAOA! Congratulations to Ingrid Mwansa of B'zoe Care - this year's HC...
09/30/2026

We're still celebrating this incredible news from HCAOA!

Congratulations to Ingrid Mwansa of B'zoe Care - this year's HCAOA Caregiver of the Year! Ingrid, you represent the very best of what home care is all about.

And to the four outstanding finalists - Kudirat Akinshiju, Lisa Ilomin, Elva "Mitsy" Rice, and Rhonda Wilson - thank you for the compassionate, exceptional care you provide every day.

We're honored to sponsor this award and recognize the caregivers who make aging in place a reality. To everyone nominated: you are the heart of our industry.

Arizona Home Care Providers: Stay Ahead of AHCCCS Eligibility ChangesNew federal Medicaid requirements are coming to Ari...
09/29/2026

Arizona Home Care Providers: Stay Ahead of AHCCCS Eligibility Changes

New federal Medicaid requirements are coming to Arizona, and eligibility verification will be increasingly important for home care agencies heading into 2027.

Beginning January 1, 2027, some adults ages 19–64 enrolled in the AHCCCS adult group will be subject to new work requirements and, in most cases, six-month eligibility renewals. AHCCCS estimates that nearly 417,000 members could be affected.

What should providers be doing now?
✅ Verify AHCCCS eligibility regularly rather than relying on prior verification.
✅ Monitor eligibility and coverage changes that could affect ongoing services and reimbursement.
✅ Confirm authorizations remain active before providing and billing for services.
✅ Keep accurate member information in your billing and care-management workflows.
✅ Stay informed as AHCCCS releases additional implementation guidance.

AHCCCS has launched https://hubs.la/Q04yszX-0 as its central resource for information about the new requirements, exemptions, six-month renewals, and other updates.

For home care agencies, the takeaway is simple: As Medicaid eligibility requirements and renewal frequency change, consistent eligibility checks can help identify potential coverage issues before they become billing problems.

Paradigm helps home care agencies manage Medicaid and VA billing, claims, authorizations, collections, and changing payer requirements.

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