When a client’s care is paid for by an insurance company, the VA, Medicaid, or another third-party payer, you can create a third-party policy by uploading the authorization document provided by the payer. Careswitch uses AI to extract the key details from the document, and Paradigm staff review the information for accuracy before the policy becomes active.
For an overview of policies and how they work in Careswitch, see What is a Policy?
Before You Start
Before creating a third-party policy, make sure you have:
The client (care recipient) already created in Careswitch.
The authorization document as a PDF. Use the original document or a clear scan whenever possible. Avoid uploading photos of paper documents.
The payer already configured in your workspace under Payers → Third-Party. If the payer has not been set up yet, add it before creating the policy.
Creating a Third-Party Policy
For VA and similar electronic third-party payers, you don't need to manually build the service groups or coverage rules. Instead, attach the authorization, and Careswitch uses the information to build the policy for you.
Navigate to the Client. Go to Clients, then select the client whose policy you would like to update.
Confirm the client’s information. Make sure the client’s profile includes a Date of Birth and Veteran ICN. A Date of Birth is required to create the policy. Careswitch also extracts these details from the authorization after it is uploaded, but they must be on the client’s profile for billing.
Click on the Policies tab.
Select the Third Party tab.
Set Payer Type to VA or Medicaid.
Select the appropriate payer, such as Veterans Affairs Community Care Network or Veterans Affairs Fee Basis Program.
Upload the authorization. Under Upload Authorization, drag and drop or browse to attach the VA SEOC (Standardized Episode of Care) or authorization letter. Files can be up to 50 MB.
Once the file has been selected, click Upload File.
If an authorization is not available yet, select No current authorization (provisional policy) to create a provisional policy instead. Learn more about provisional policies here. You will need to include at least one piece of documentation:
Supporting Documentation — Upload payer correspondence, notes from verbal confirmation, or other documentation showing that the authorization is pending.
Reference a Prior Policy — Link the expired or previous policy if the client’s care is continuing. This carries over the previous policy’s services and limits so the provisional policy starts with the same coverage.
Create the policy. Click Create Policy. The policy will start in a pending status while the authorization is being processed.
What Happens Next?
Once the authorization is submitted, Careswitch handles the remaining setup:
Validates the authorization and extracts the client’s Date of Birth and Veteran ICN.
Builds the service groups and coverage rules automatically, including covered services, procedure codes (such as G0162), authorization limits, applicable constraints, and coverage dates.
Notifies you when the authorization is approved.
Activates the policy for primary billing, allowing the assigned services to be billed against it.
Authorization Stages After Submitting:
The authorization will go through the following stages:
Processing
Careswitch is processing the authorization and using AI to extract key information from the document, including:
Client name and identifiers
Payer and plan
Authorization, referral, and policy numbers
Coverage start and end dates
Covered services and limits, such as hours, visits, or dollar amounts
Diagnosis codes, when applicable
Processing typically takes a minute or two. No action is needed while the document is being processed.
Pending
Once processing is complete, the policy moves to Pending. At this stage, Paradigm staff review the information extracted from the authorization to make sure it is accurate.
This review is important because insurance authorizations are legally binding documents, and an incorrect number or date could result in claim issues later.
Review is typically completed the same day during business hours. No action is needed from you while the policy is pending.
Active
Once the authorization has been approved, the policy becomes Active. You can then:
Schedule shifts using the authorized services.
Monitor usage against the policy’s limits in real time.
Generate invoices and claims using the policy’s authorization information and applicable rates.
Rejected
If the authorization cannot be validated, the policy will show a Rejected status along with a reason.
Common reasons include:
Wrong client: The authorization belongs to a different client.
Expired document: The authorization's coverage period has already ended.
Duplicate: A policy for the same authorization already exists in Careswitch.
Unreadable: The document is too low-quality, incomplete, or blank for the information to be extracted.
Wrong payer: The payer selected does not match the payer listed on the authorization.
If a policy is rejected, correct the issue and resubmit the authorization. For example, you may need to upload a clearer document, attach the authorization to the correct client, or select the correct payer.
Status | What it means |
Processing | Careswitch is processing the uploaded authorization document and extracting information from it. |
Pending | The extracted information is being reviewed by Paradigm staff. |
Active | The Policy is active and can be used for scheduling and billing. |
Partially Active | Some Service Groups are active while others have expired or been made inactive. The active Service Groups can still be used for billing. |
Inactive | All Service Groups are inactive or have expired. The Policy cannot be used for new billable care. |
Rejected | The Policy could not be approved. A reason for the rejection will be provided so you can correct the issue and resubmit it, when applicable. |
Archived | The Policy was manually archived and is retained for historical records. |
Renewing or Replacing an Authorization
When an insurance payer issues a new authorization, such as a renewal, extension, or replacement, create a new policy rather than editing the existing policy.
Careswitch keeps the previous policy on file as inactive or archived for historical reference, while the new policy becomes available for new shifts.
Fixing Incorrect Details on an Approved Authorization
Once a third-party policy is approved, its authorization details are locked to match what the payer authorized. This includes the services, service groups, units and limits, coverage dates, and payer.
If you find an error on an active policy, contact Careswitch Support through the in-app chat. Include the correction you need or provide the corrected authorization document. The Careswitch team can update the authorization details for you.
Important: This process is only for correcting an error in an existing authorization.
If the payer has issued a new, renewed, or amended authorization, or the previous authorization has expired, create a new policy instead. See Renewing or Replacing an Authorization above.
Tips to Avoid Rejections
Upload the clearest copy available. Whenever possible, use the original PDF provided by the payer rather than a photo or scanned copy.
Verify the client information. Before uploading, compare the client’s name and Date of Birth on the authorization with the information in Careswitch.
Select the correct payer. If the authorization is from a managed care organization (MCO) under a parent plan, select the specific MCO listed on the authorization rather than the parent plan.
Check for duplicates. Before creating a new policy, check the client’s Policies tab to make sure the authorization hasn’t already been added.