For a full concept overview, see What is a Policy?.
Setup and basics
Does every client need a policy?
Yes. Every client, including private-pay clients, needs a policy before care can be billed.
A policy tells Careswitch who pays, which services are covered, and when coverage applies.
You can schedule shifts before adding a policy. To bill them, however, you'll need a policy with a service group covering the shift's service and date. Whenever possible, set up the policy before care begins.
Can one client have multiple policies?
Yes. Multiple policies can cover different payers, services, or periods of care. For example, a client may have:
A primary insurance policy and a private-pay policy for additional hours.
Two insurance authorizations for different services.
Separate policies for different periods of care.
Careswitch chooses a policy for each shift based on its service and date. If several policies cover the same service and date, it uses this priority order:
Third-party policies: VA first, then Medicaid, then other insurance. A policy with an actual authorization takes priority over a provisional policy.
The private-pay policy marked Default for Invoicing for the service.
The most recent private-pay policy.
What's the difference between a policy and a service group?
A policy is the overall authorization or agreement for a client's care.
A service group identifies the care services covered by that policy, along with their coverage dates and usage limit.
One policy can contain multiple service groups. For example, an insurance authorization may cover Personal care for 20 hours per week and Respite for 40 hours per quarter. Each is a separate service group within the same policy.
What if care needs to continue before the authorization arrives?
You can create a provisional policy when care must begin or continue while you're waiting for authorization. This may apply when a caseworker hasn't sent the document yet or you've been instructed to continue care while it is processed.
To create a provisional policy:
On the third-party policy form, turn on No current authorization (provisional policy).
Provide at least one of these:
Supporting Documentation, such as payer correspondence or notes about verbal confirmation.
Reference a Prior Policy, identifying the expired or previous policy that this care continues. Careswitch copies its service groups and coverage dates into the provisional policy.
Submit the policy. It starts as Pending while Paradigm reviews it and can't be used for billing until approved.
Once approved, you can schedule shifts, track usage, and add shifts to invoices. Claims can't be submitted while the policy is provisional.
When the authorization arrives, open the policy and click Upload authorization. The policy returns to Pending during Paradigm's review, and claim submission remains blocked. Approval converts it to a standard policy and allows claims to be submitted.
If the authorization is rejected, the policy remains provisional and shows the reason. Upload a corrected document to continue.
For step-by-step instructions, see Provisional Policies.
Status and review
What does Processing mean?
Processing applies only to VA policies. Careswitch's AI assistant is reading the uploaded authorization. When this finishes, the policy moves to Pending for review.
Why is my third-party policy still Pending?
Pending means Paradigm is reviewing and verifying the authorization before it can be used for billing. For VA policies, the team checks the details extracted by AI. For other payers, the team enters details from your document.
Most reviews finish the same day during business hours. If yours is taking longer than expected, contact us through in-app Chat so we can check its status.
What should I do if a policy is Rejected?
Open the policy and read the Authorization Rejected banner. It lists the reviewer's reasons, which may include:
The authorization belongs to someone other than the client.
It had already expired when added.
The document isn't an authorization.
Patient identifiers, such as name, SSN, or VA file number, don't match the client.
The file is corrupted, unreadable, or in an unsupported format.
The authorization duplicates one already submitted.
Click Re-upload Authorization and upload the corrected document. The same policy returns to Pending for review, so you don't need to create another one.
If you selected the wrong client, create the policy on the correct client's profile instead.
For more information, including common rejection reasons, see Creating a Third-Party Policy.
What does "Partially Active" mean?
Partially Active means some service groups are active and others have expired or been set inactive.
You can still use the policy for shifts covered by its service groups. An expired group can cover a past shift if the shift's date falls within that group's coverage dates.
Editing policies
Can I edit a policy after it's approved?
It depends on the type of policy.
Private-pay policies
You can edit active, partially active, inactive, or pending private-pay policies to:
Update rates.
Add or remove service groups.
Change service group coverage dates and limits.
Archived and rejected policies can't be edited. For an archived policy, unarchive it first.
Third-party (insurance) policies
Authorized services, limits, and coverage dates on approved third-party policies are locked because they reflect the payer's authorization.
If the payer issues a new or updated authorization, submit it as a new policy.
For instructions, see Creating a Third-Party Policy.
How do I correct information on a third-party policy?
You can't directly edit the authorized details, including:
Services and service groups.
Units and limits.
Coverage dates.
Payer.
Contact Careswitch Support through in-app Chat. Explain the correction or provide the corrected authorization document. Our team can update the details for you.
These changes appear as Careswitch Admin in the policy's activity.
What if an authorization expires or the payer sends a new one?
To replace an expired authorization or use a new or amended authorization, submit it as a new policy. You don't need to contact Support for this.
Instead, submit the new authorization as a new policy. See Creating a Third-Party Policy.
Can I extend a policy past its end date?
It depends on the policy type:
Private-pay: edit the policy and update the service group's Coverage End Date. Saving a future end date makes an expired service group active again.
Third-party: the payer must issue a new or amended authorization. Submit it as a new policy.
How do I turn off a service group without ending the whole policy?
For a private-pay policy:
Open the policy.
Find the service group you want to turn off.
Set the service group to Inactive.
The group stays visible but is no longer used for billing. Other groups remain active, and the policy becomes Partially Active.
To reactivate it, use ⋮ → Set Active. This is available only if its coverage end date hasn't passed.
For a third-party policy, contact Careswitch Support through in-app Chat to turn off a service group. These groups reflect the payer's authorization.
Limits and usage
What happens when a service group reaches its limit?
The usage bar changes color as usage increases: amber at 50%, orange at 80%, and red at 100%.
When creating or editing shifts and schedules, anything that would exceed the limit is flagged Overage. You can also use the Overage filter on the Schedules list.
Careswitch sends Policy Overage Detected to workspace admins and users with permission to manage policies when:
A policy becomes active and is already over a limit.
Editing a policy causes an overage.
A late clock-out pushes usage over a limit.
Recipients receive an in-app notification, plus email or push notifications according to their settings. Scheduling new shifts beyond the limit doesn't send this notification, but the shifts are flagged.
Exceeding a limit doesn't prevent scheduling or make shifts unbillable. Instead:
Invoices with an overage move to Needs Review. You can mark them ready and send them anyway.
Claims exceeding an authorization limit aren't submitted automatically. You can review and submit them manually.
Your team must decide what to do next, such as obtaining a new authorization or adjusting the care plan.
How does Careswitch calculate usage?
Careswitch updates usage as shifts are scheduled and completed. A service group's usage includes:
Completed shifts, whether billed or not.
Upcoming scheduled shifts.
Missed shifts.
Any Starting Used amount entered for the group.
On the policy detail page, groups with a limit show the percentage used for the current limit period, such as Monthly Limit Utilized, and the amount remaining.
Upcoming shifts already count toward usage, so remaining reflects what's left after the current schedule. It never falls below zero. When usage exceeds the limit, the percentage rises above 100%.
When creating or editing a shift or schedule, the utilization panel shows used, projected, and remaining. In this panel, projected means the change your edit would make.
an I include care provided before the policy was added?
For private-pay policies, create or edit the service group, turn on Advanced Controls, select Already used?, and enter Starting Used. This amount is included when calculating the remaining balance.
For third-party policies, send the amount already used to Careswitch Support through in-app Chat. Our team will record it.
Billing
Why wasn't the policy I expected used for a shift?
Careswitch selects a policy based on the shift's service and date, following the priority order.
If the wrong policy was selected, or none was found, check that:
The shift's date falls within both the policy's and service group's coverage dates.
The service is included in a service group.
The group isn't Inactive. Expired groups still cover past shifts within their dates.
The policy is approved. Pending, Processing, Rejected, and Archived policies aren't used for billing.
Another policy doesn't take priority. Third-party policies take priority over private-pay policies, including those marked Default for Invoicing.
The shift isn't locked to a policy through Specify policy? or Change Policy.
Can I move a shift to a different policy?
Yes. You can override automatic policy selection:
Completed shifts, including canceled shifts with billable hours: use Change Policy, following the steps below.
Scheduled shifts: edit the shift, turn on Specify policy?, and choose from Select Policy. Apply the change to one shift or all following shifts. This option isn't available once the shift is on an invoice or claim.
This can help when the wrong policy was used or when private-pay or provisional coverage was used while waiting for Medicaid or VA authorization.
Change the policy on a completed shift
Open the shift.
Click the More dropdown and select Change Policy.
Choose a policy from Policy. The list includes approved policies covering the service on the shift's date, even if they have since expired. Provisional policies show Provisional, and the existing policy shows (current). Manually inactivated, pending, rejected, and archived policies aren't listed.
Review the preview. The side panel compares authorization usage under the old and new policies using the selected policy's billing rate for the shift.
Click Save Changes.
Careswitch then:
Locks the shift to the new policy and recalculates the bill rate, replacing any manually set bill rate. For hourly shifts, it also recalculates rounding.
Removes the billing items from any open invoice or claim created under the previous policy.
Returns the shift to Billable. You must manually add it to an invoice or claim under the new policy.
When Change Policy is unavailable
Change Policy is available only for shifts within the last 180 days that have billable hours. It is also blocked, with an explanation, if the shift:
Has been billed or paid. Void the invoice or claim first.
Is on a reviewed invoice. Select Mark Open first.
Is on a submitted claim. Void or reverse the claim first.
Choose the policy for future shifts
Private-pay: on the client's service, open the policy menu and select Set as Default for Invoicing. It applies to shifts without a locked policy, provided no third-party policy covers the same service and date.
Third-party: submit the new authorization as a new policy. Once approved, unbilled shifts without a locked policy automatically move to it when it is the best match.
Correct a shift billed under the wrong policy
If the shift is on an open invoice or claim, use Change Policy. Careswitch removes it from the old invoice or claim for you.
If the invoice was sent or the claim submitted:
Confirm the correct policy is approved and covers the shift's date.
Release the shift from the old billing:
Private-pay invoice: use Mark Void and Reopen.
Claim: use Void & release shifts. If the payer has already paid part of the claim, paid lines remain billed and can't be moved.
Open the shift, select More → Change Policy, and choose the correct policy.
Add the shift to a new invoice or claim under that policy.
You can also remove a Billable shift from an open invoice and add it again through Billing → Items. Use Remove from Invoice, then Add to Invoice or Add to Claim to have Careswitch select the policy again.
This works only for shifts without a locked policy. A shift assigned using Change Policy or Specify policy? keeps that policy.