Optimizing Home Care: Paradigm’s Solution To A Messy Process
As of July 1, 2024, the Idaho Department of Health and Welfare has increased reimbursement rates for home care services. This, combined with a promising market outlook, makes Medicaid home care a highly attractive opportunity. Despite these advantages, home care providers often face challenges due to the complexities of multiple systems, including intricate billing processes and Electronic Visit Verification (EVV) requirements. These obstacles can distract from their core mission of growth and success. Paradigm addresses these challenges by alleviating administrative burdens. Our solutions automate billing, streamline EVV data, and more, allowing agencies to focus on what truly matters: fully leveraging the market potential and positively impacting the lives of their clients.
How Paradigm Helps.
Billing
Enrollments
Eligibility
EVV Support
Training
MedicaidinIdaho.
Electronic Visit Verification
Providers are often perplexed by the unclear dynamics of Idahoan Medicaid and billing regulations, so here we clarify the particulars. EVV (Electronic Visit Verification) is a technology used to verify that home or community-based service visits occur. The purpose of EVV is to ensure that services are delivered to members and that providers only bill for services rendered.
EVV Requirements:
Idaho uses the Provider Choice Model, meaning that providers may use the state sponsored aggregator Sandata or any alternative EVV that integrates with it.
EVV Aggregator:
As the state aggregator, Sandata handles the transmission of all EVV data to the payer. To ensure compliance and prevent payment and audit issues, it is crucial that all claims follow EVV guidelines.
Billing process:
Providers can submit claims directly through the state portal (Health PAS) or by utilizing a third-party clearinghouse.
Rates
Idaho Medicaid reimbursement rates were updated as of July 2024 and now range between $21.12 and $24.44 per hour, more than triple the Idaho minimum wage.
It's important to note that rates for MCOs (Managed Care Organizations) can vary based on how each contract is negotiated with agencies. Agencies must conduct detailed evaluations of MCO contracts to secure the best possible rates.
Payers
The Idaho Department of Health and Welfare (IDHW) authorizes and disperses all Medicaid.
Idaho has a hybrid system. There are two branches that deliver managed care: Medicaid Medicare Coordinated Plan (MMCP) and Idaho Medicaid Plus (IMPlus). IMPlus is a program for participants eligible for both Medicare and Medicaid and is administered by two MCOs, Blue Cross and Molina Healthcare. Idaho also has two waiver programs; the Aged and Disabled (A&D) Waiver and the Adult Developmental Disabilities (DD) Waiver.
