Policies are the rulebook for one client's care. They tell Careswitch who's paying, what services are covered, how much care is authorized, and through when. Without an active policy on file, a client can't be billed for care.
The simple mental model: a prepaid gift card
If it helps, think of a policy like a prepaid gift card for care:
It has a balance: the limit (hours, visits, or dollars).
It has an expiration date: the coverage end date.
It can only be used at specific stores: the services it covers.
It's issued by someone specific: the payer.
Each shift "swipes the card": usage is tracked automatically.
Your job is to make sure every client has at least one valid card on file, and to keep an eye on the balances so you don't get caught off-guard.
Two kinds of policies
Private-Pay Policies
The client or their family is paying directly. You just type in the details — start date, end date, services, the bill rate — and the policy is active immediately. No approval needed. You're in full control.
Third-Party (Insurance) Policies
Someone else is paying — the VA, Medicaid, a managed care org, or another insurance plan. These are more involved:
You upload the authorization document the insurance sent you.
Our system uses AI to read it and pull out the key details.
The policy goes to Paradigm staff for human review before it goes live.
Once approved, you can bill against it.
The reason for that review step: insurance authorizations are legally binding documents. One wrong digit on a unit count or date can mean a denied claim months later, so a human double-checks what the AI extracted.
Service Groups: the building blocks inside a policy
A policy isn't a single rule — it's a container for one or more service groups. A service group is a bundle of authorized care with its own limit.
Example: a single VA authorization for "Margaret Smith" might contain:
Service Group 1: Personal Care — 20 hours/week, through 9/30/2026.
Service Group 2: Respite Care — 40 hours/quarter, through 9/30/2026.
Each service group tracks its own usage independently. You can run up to your personal-care limit without affecting respite.
Service groups can also be turned on or off individually. If the insurance pulls back respite coverage but keeps personal care, you'd mark just the respite group inactive — the policy itself stays partially active.
Policy status: what each label means
When you look at a client's policies list, here's what each status tells you in plain terms:
Processing: our AI is reading the document you uploaded. Usually takes a minute or two.
Pending: Paradigm staff are reviewing what the AI extracted. Hands off — just wait.
Active: good to go. You can schedule shifts and they'll bill against this policy.
Partially Active: some of the service groups inside are active, others have expired or been turned off. Still billable for what's active.
Inactive: all service groups have run out or expired. No new shifts can bill to this policy.
Rejected: the AI or Paradigm flagged a problem (wrong client, expired doc, duplicate, etc.). You'll see a reason and can fix and resubmit.
Archived: manually turned off, kept for history.
How policies work day-to-day
You don't really "use" the policy directly — it works in the background:
When you schedule a shift: Careswitch checks the client's active policies and picks the right one based on the service being delivered.
When the shift is completed: usage automatically counts against that service group's limit.
When you're close to the limit: you'll see warnings before you run out.
When you bill or send claims: Careswitch uses the policy's payer info, authorization number, and rates to build the claim correctly.
Where to find policies in Careswitch
Per client: open the care recipient profile → Policies tab.
Per payer: Payers → Third-Party Payer → Policies tab (useful for seeing every client on the same insurance).
Once you've got the concept down, head to the right how-to guide depending on the kind of policy you need to set up — private-pay or third-party.