Overview
For agencies that support individuals with intellectual and developmental disabilities (IDD), billing isn’t just paperwork, it’s survival. Getting reimbursed through Medicaid and managed care programs is what keeps the lights on, staff paid, and services running. But the billing process is often complex, time-consuming, and has lots of room for error.
Unlike other areas of healthcare, IDD billing depends heavily on detailed service documentation, compliance with state-specific waiver rules, and accurate tracking of time, locations, and outcomes. A single missing signature or incomplete note can delay payment, or cause a claim to be denied altogether.
If billing has ever felt like a maze your agency can’t quite navigate, you’re not alone. Here’s what makes IDD billing so complicated, and what agencies need to know to do it right.
Who pays for what
The majority of funding for IDD services comes through Medicaid, but not all Medicaid is the same. Many states use Home and Community-Based Services (HCBS) waivers to fund long-term supports like residential care, day programs, or supported employment. These waivers come with specific rules around what services are covered, how often they can be delivered, and who qualifies.
On top of that, many states have shifted to managed care models, where payments are routed through Managed Care Organizations (MCOs). Each MCO can have its own billing system, documentation requirements, and reimbursement timelines. For agencies, this means juggling multiple payers—and understanding the fine print in each one.
Billing starts with documentation
In the IDD world, if it isn’t documented, it didn’t happen, if it didn’t happen, you won’t get paid. Every claim submitted to Medicaid or an MCO must be backed by clear, complete service documentation. That includes start and end times, staff credentials, location, service type, and a narrative of what was done.
It also has to tie back to the individual’s approved plan of care. Services must match authorized goals and be delivered in the timeframes and settings outlined in the Individualized Service Plan (ISP). This level of specificity makes real-time documentation not just helpful, but essential.
Common pitfalls
Even experienced agencies can run into billing issues. Some of the most common include:
Missing time in/out entries or signatures
Documentation that doesn’t align with the ISP
Submitting claims outside of the authorized date range
Forgetting to include required modifiers or billing codes
Using outdated service descriptions from the wrong waiver year
Each of these can lead to a denied or delayed claim. When you multiply that by dozens or hundreds of services per week, the impact adds up fast.
Manual billing takes time
Billing for IDD services is often still done manually, with staff pulling data from different systems (or paper), compiling it into spreadsheets, and hoping it’s clean enough to submit. It’s labor-intensive, error-prone, and pulls valuable team members away from supporting individuals or growing the agency.
Manual systems also make it harder to spot trends, follow up on unpaid claims, or generate the reports needed for audits, MCO reviews, or board reporting. In short: billing by hand is a risk your agency doesn’t have to keep taking.
Accurate billing benefits
Getting billing right isn’t just about compliance, it’s about stability. Timely, accurate billing keeps cash flow predictable and frees up leadership to focus on service quality, staff development, and growth. It reduces the burden on admin teams, minimizes audit stress, and gives your agency more control over its financial future.
For many agencies, strengthening the billing process is the first step to building long-term sustainability.
Simplify billing with Giv
At Giv, we know that billing is where good documentation, strong systems, and smart automation all come together. Our platform was built specifically for IDD providers to make this part of the job less overwhelming, and far more reliable.
With Giv, staff document services in real time, using mobile-friendly tools that capture everything Medicaid requires: time in/out, service type, ISP alignment, and more. That data flows directly into billing exports that are clean, complete, and ready for submission. No duplicate entry. No last-minute scrambling.
Supervisors can review and approve notes from anywhere. Leadership can track unbilled services, run reports by individual or program, and always know where things stand. Whether you're billing through Medicaid directly or managing multiple MCO contracts, Giv helps you stay organized, audit-ready, and focused on care. Learn more by exploring our product here.
