Sometimes you need to start or continue care before you receive the authorization. For example, you may be waiting for the caseworker to send it, or you may have been instructed to continue providing care while the authorization is pending.
A provisional policy allows you to set up the client, schedule shifts, and track usage while you wait for the authorization. Once you receive the actual authorization, you can convert the provisional policy to a standard policy.
How to Create a Provisional Policy:
Follow steps 1-6 here.
If an authorization is not available yet, select No current authorization (provisional policy) to create a provisional policy instead.
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.
4. Click Create Policy.
5. The policy will be created as a provisional policy
Converting a Provisional Policy
Once you receive the actual authorization from the payer:
Open the provisional policy
Click Documents.
Click Add.
Select Authorization as the document type in the dropdown.
Upload the actual authorization document from the payer. Supporting documentation added when creating the provisional policy does not replace the authorization.
Click Upload File.
Click Save.
The policy will be sent back to Paradigm for review.
Once approved, the policy becomes a standard policy, and you can submit insurance claims.
Important: Converting a provisional policy is a one-way process. Once converted to a standard policy, it cannot be changed back to provisional.
What You Can and Can't Do With a Provisional Policy
Once Paradigm approves a provisional policy, it works like a standard policy in most ways.
You can: Schedule shifts, track usage against coverage limits, and include shifts on invoices.
You can't: Submit insurance claims. Claim submission is blocked while the policy is provisional. If you try to submit a claim, Careswitch will prompt you to convert the policy to a standard policy first.
A Provisional badge appears wherever the policy is displayed, making it easy to identify that the policy is being used while the final authorization is pending.
