Quick answers to the most common questions about policies. For the full concept overview, see What is a Policy?.

Every client needs at least one active policy on file to bill their care — private-pay included. It's how Careswitch knows what to charge and for what services. You can schedule shifts without a policy, but they can't be billed until a policy covering that service and date is in place — so set the policy up before care starts, or as soon as possible after.

Yes. A client might have a primary insurance policy plus a private-pay top-up for additional hours, or two separate insurance authorizations covering different services. Careswitch automatically picks the right policy for each shift based on the service, dates, and payer.

A policy is the overall authorization or agreement. A service group is a specific bundle of care within that policy, with its own limit. One policy can have multiple service groups — for example, a single insurance auth might cover both personal care (20 hours/week) and respite (40 hours/quarter) as two separate service groups under the same policy.

If you need to deliver care before the payer's authorization arrives — you're waiting on the caseworker, or they've told you to continue care in the meantime — create a provisional policy. On the third-party policy form, turn on No current authorization (provisional policy), then attach supporting documentation (payer correspondence or verbal-confirmation notes) and/or reference the prior policy this care continues. You can schedule shifts, track usage, and add shifts to invoices as normal, but claim submission stays blocked until you upload the real authorization and Paradigm converts it to a normal policy. See How to submit a Third-Party Authorization for the full walkthrough.

Pending means Paradigm staff are reviewing the AI's extraction of your authorization document. Most reviews complete same-day during business hours. If it's been longer than expected, reach out via in-app chat and we'll check on it.

The rejection includes a reason. Common ones: wrong client attached, expired document, duplicate of an existing policy, unreadable PDF, or wrong payer selected. Fix the underlying issue and resubmit as a new policy. See How to submit a Third-Party Authorization for the full list of common rejection reasons.

Some of the service groups inside the policy are active, others have expired or been turned off. The policy is still usable — shifts will bill against whichever service groups are still active.

For private-pay policies, yes — you can update rates, add or remove service groups, and adjust coverage dates anytime. For third-party (insurance) policies, the core authorization details (services, limits, dates) are locked once approved because they reflect what the payer authorized. If the payer issues an updated authorization, upload it as a new policy.

The authorized details on a third-party (insurance) policy — its 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 any of that is wrong (for example, the wrong unit count, the wrong service group, or an incorrect date), 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.

One thing you can handle yourself: if the authorization has simply expired and you just need a fresh one — or the payer has issued a new or amended authorization — you don't need us. Submit it as a new policy: see How to submit a Third-Party Authorization.

For private-pay, yes — edit the coverage end date. For third-party, no — extensions come from the payer in the form of a new or amended authorization, which you'd upload as a new policy.

Open the policy, find the service group, and set it to Inactive. The rest of the policy stays usable.

Careswitch warns you as you approach the limit and flags the overage — the policy's utilization reflects it (including projected usage from upcoming shifts), and workspace admins get an overage notification. It does not hard-stop scheduling, though: you can still create shifts past the limit, so it's up to your team to act on the warning — secure a new authorization, adjust the plan, and so on. Shifts already scheduled within the cap remain billable.

Usage rolls up automatically as shifts are scheduled and completed — the policy's utilization includes both billed shifts and projected usage from upcoming scheduled shifts, so you can see where you'll land before you get there. The remaining balance shows on the policy detail page.

Yes. When you create or edit a service group, set the "starting used" amount to reflect the units consumed before the policy was added. This way, Careswitch's remaining-balance math stays accurate.

Careswitch picks the policy based on the shift's service, date, and payer. If the wrong policy was used (or no policy was matched), check that:

By default, Careswitch resolves each shift's policy automatically from the service, date, and payer — so usually you don't pick one. But you can override it on a single shift: open the shift, turn on Specify policy?, and choose the policy you want it to use. To change the default going forward instead: for private-pay, set the service's effective policy; for third-party, set up the new authorization and new shifts resolve to it automatically.

To correct shifts that already billed under the wrong policy, first make sure the correct policy is the active one, then re-bill them: on Billing → Items, use Remove from Invoice on the shift (it returns to Billable), then Add to Invoice again so it re-resolves to the now-correct policy. You can do this while the invoice is still open; if it's already been sent, void and reopen it first, and a shift attached to a submitted claim has to come off the claim before it can move.

Follow How to create a Private-Pay Policy — it's a 5-minute walkthrough.

Follow How to submit a Third-Party Authorization.

Still not sure? Start with What is a Policy? for the concept overview, or the step-by-step guides linked above.