When a client's care is being paid for by an insurance company, the VA, Medicaid, or another third-party payer, you create a third-party policy by uploading the authorization document the payer sent you. Careswitch's AI extracts the key details, and Paradigm staff review the result before the policy goes live.
For background on what policies are and how they fit in, see What is a Policy?.
Before you start
You'll need:
The client (care recipient) already created in Careswitch.
The authorization document as a PDF (clear scan or original — no photos of paper if you can avoid it).
The payer already configured in your workspace (Payers → Third-Party). If the payer isn't there yet, set it up first.
Step-by-step
Go to the client's profile → Policies tab.
Click Create Policy.
Choose the payer (e.g., VA, Medicaid plan, commercial insurance).
Upload the authorization PDF. Drag and drop, or click to browse.
Confirm and submit. The policy enters Processing status — Careswitch's AI starts reading the document.
What happens after you submit
Processing
Our AI is reading the document and pulling out:
Client name and identifiers.
Payer and plan.
Authorization number, referral number, policy number.
Coverage start and end dates.
Services covered and their limits (hours, visits, or dollar caps).
Diagnosis codes, where applicable.
This usually takes a minute or two. No action needed from you.
Pending
Once the AI is done, the policy moves to Pending — Paradigm staff review what was extracted to make sure nothing's off. This step is important because insurance authorizations are legally binding documents, and a wrong digit or date can cause denied claims months later.
Turnaround is typically same-day during business hours. Nothing for you to do — just wait.
Active
The policy is approved and live. You can:
Schedule shifts against the authorized services.
Watch usage track in real time against the limits.
Generate invoices and claims using the policy's authorization number and rates.
Rejected
If something didn't validate, you'll see a Rejected status with a reason. Common reasons:
Wrong client: the document is for a different person than the client you uploaded it under.
Expired document: the coverage period has already ended.
Duplicate: a policy already exists in Careswitch for this exact authorization.
Unreadable: the PDF is too low-quality, partial, or blank for the AI to extract.
Wrong payer: the payer selected doesn't match what's on the document.
Fix the underlying issue (re-scan the document, attach it to the right client, pick the right payer, etc.) and resubmit.
No authorization yet? Create a provisional policy
Sometimes you need to start or continue care before the authorization is in hand — you're waiting on the caseworker to send it over, or they've told you to keep providing care in the meantime. A provisional policy lets you set the client up, schedule shifts, and track usage during that gap, then convert it to a normal policy once the real authorization arrives.
How to create one
Start a third-party policy the same way: the client's profile → Policies tab → Create Policy → choose the payer.
Turn on the No current authorization (provisional policy) toggle.
Add at least one piece of evidence for what you're continuing (see below).
Confirm and submit. Like any third-party policy, it goes to Paradigm for review before it becomes active.
You need at least one of these:
Supporting Documentation — payer correspondence, verbal-confirmation notes, or other proof of the pending authorization.
Reference a Prior Policy — link the expired or previous policy this care continues. This carries the prior policy's services and limits over, so the provisional policy starts with the same coverage.
What you can and can't do with it
Once Paradigm approves it, a provisional policy behaves like a normal policy in almost every way:
You can schedule shifts, track usage against the limits, and add shifts to invoices.
You can't submit insurance claims yet — claim submission is blocked while the policy is provisional. If you try, Careswitch will tell you to convert the policy to a normal policy first.
A Provisional badge marks the policy wherever it appears, so it's clear at a glance that it's standing in for a not-yet-received authorization.
Converting it once the authorization arrives
Open the policy and click Upload authorization.
Upload the real authorization document from the payer. The supporting documentation you added earlier doesn't count for this step — it has to be the actual authorization.
The policy converts and goes back to Paradigm for review, just like a normal submission. Once approved, it's a normal policy and claims can be submitted.
Converting is one-way — a normal policy can't be turned back into a provisional one.
Renewing or replacing an authorization
When the insurance issues a new authorization (a renewal, an extension, or a replacement after a change), upload it as a new policy rather than editing the old one. Careswitch keeps the previous policy on file as inactive/archived for historical reference, while the new one takes over for any new shifts.
Fixing wrong details on an approved authorization
Once a third-party policy is approved, its authorization details — the services, service groups, units and limits, dates, and payer — are locked to match what the payer authorized, so your team can't edit them directly. If you spot something wrong on an active policy (a wrong unit count, the wrong service group, an incorrect date, and so on), flag it to Careswitch support in the in-app chat and include the correction — or the corrected authorization document. Our team will update the authorization details within the policy for you.
This is only for correcting mistakes in an existing authorization. If the payer has issued a new, renewed, or amended authorization, or the old one has simply expired, you don't need us — upload it yourself as a new policy (see Renewing or replacing an authorization above).
Tips to avoid rejections
Upload the cleanest copy you have. The original PDF from the payer beats a phone photo every time.
Make sure the client matches. Cross-check the client name and DOB on the document against the Careswitch client record before uploading.
Check for the right payer. If the document is from a managed care org under a parent plan, pick the specific MCO in Careswitch — not the parent.
Don't duplicate. Before uploading, check the client's Policies tab to see if this authorization is already on file.
If you're setting up care for a private-paying client instead, use How to create a Private-Pay Policy.