For a full concept overview, see What is a Policy?.

Yes. Every client needs at least one active policy on file before their care can be billed, including private-pay clients.

A policy tells Careswitch who is paying, what services are covered, and when the coverage applies.

You can schedule shifts without a policy, but those shifts cannot be billed until a policy covering the service and date is added. For this reason, set up the policy before care begins whenever possible.

Yes. A client can have multiple policies when different payers, services, or coverage periods apply.

For example, a client might have:

Careswitch automatically determines which policy applies to each shift based on the service, dates, and payer.

A policy is the overall authorization or agreement for a client's care.

A service group is a specific set of care services covered under that policy, along with its own usage limit.

One policy can have multiple service groups. For example, a single insurance authorization might include:

Each would be set up as a separate service group under the same policy.

If you need to provide care before you receive the payer's authorization, you can create a provisional policy. This may apply when you're waiting for the caseworker to send the authorization or when you've been instructed to continue providing care while the authorization is being processed.

To create a provisional policy:

A provisional policy allows you to schedule shifts, track usage, and add shifts to invoices as usual. However, claim submission remains blocked until the actual authorization is uploaded and Paradigm converts the provisional policy to a standard policy.

For step-by-step instructions, see Provisional Policies.

Pending means Paradigm is reviewing the AI's extraction of your authorization document.

Most reviews are completed the same day during business hours. If your policy has been pending longer than expected, contact us through in-app Chat and we'll check on its status.

The rejection includes a reason explaining why the policy could not be approved.

Common reasons include:

Correct the issue identified in the rejection reason, then resubmit the authorization as a new policy.

For more information, including common rejection reasons, see Creating a Third-Party Policy.

Partially Active means that some service groups in the policy are active while others have expired or have been turned off.

The policy can still be used. Shifts will be billed against the service groups that are currently active.

It depends on the type of policy.

Yes. You can edit a private-pay policy at any time to:

The authorization details on an approved third-party policy are locked because they reflect what the payer authorized. This includes services, limits, and coverage dates.

If the payer issues a new or updated authorization, submit it as a new policy.

For instructions, see Creating a Third-Party Policy.

The authorized details on a third-party policy are locked and cannot be edited directly. This includes:

If any of these details are incorrect, contact Careswitch Support through in-app Chat. Include the correction you need or provide the corrected authorization document, and our team can update the authorization details for you.

If you simply need to replace an expired authorization or the payer has issued a new or amended authorization, you do not need to contact Support.

Instead, submit the new authorization as a new policy. See Creating a Third-Party Policy.

It depends on the policy type:

You can deactivate an individual service group without ending the entire policy.

The remaining active service groups will continue to be available under the policy.

Careswitch warns you as a service group approaches its limit and flags any overage.

The policy's utilization includes both completed/billed shifts and projected usage from upcoming scheduled shifts, so you can see when you're approaching or exceeding the authorized limit. Workspace admins also receive an overage notification.

Careswitch does not prevent you from scheduling shifts after a service group reaches its limit. Your team is responsible for taking action, such as obtaining a new authorization or adjusting the care plan.

Shifts that were scheduled within the service group's authorized limit remain billable.

Careswitch automatically updates policy usage as shifts are scheduled and completed.

Policy utilization includes:

This allows you to see both how much of the authorization has already been used and where usage is expected to be based on the current schedule.

You can view the remaining balance on the policy detail page.

Yes. When creating or editing a service group, enter the amount of care that was already used in Starting used.

This tells Careswitch to include the previously used units when calculating the service group's remaining balance.

Careswitch automatically selects a policy based on the shift's service, date, and payer.

If a shift was assigned to the wrong policy—or no policy was matched—check the following:

Yes. Careswitch normally selects the policy automatically, but you can override the policy for an individual shift.

The process depends on the policy type:

If a shift has already been added to an invoice, you can remove it and add it again so Careswitch can resolve the policy again.

If the invoice has already been sent, you must void and reopen it before making this change.

If the shift is attached to a submitted claim, it must be removed from the claim before the policy can be changed.