Centre back Jose Maria Gimenez put holders Uruguay in front after 29 minutes with a header from Carlos Sanchez' corner, the ball going in off the post.
Paraguay equalised on the stroke of halftime from a corner taken by Edgar Benitez that striker Lucas Barrios nodded emphatically past Fernando Muslera.
The Paraguayans have five points from three matches while Uruguay, sure of a berth in the quarter-finals at least as one of the two best third-placed teams, and Argentina have four apiece.
Jamaica will finish bottom even if they manage to get an upset win over Argentina.
"I'm happy with Paraguay's strength, we're a good team," Barrios told reporters. "We were a goal down and drew against tough opponents.
Uruguay had most of the chances in a match that pitted the two finalists of the previous tournament in 2011 against each other.
Gimenez almost put the holders two up in the 37th minute but Justo Villar made a fine save, diving to his right to push the ball away.
Striker Diego Rolan latched on to the rebound and fed Edinson Cavani but the striker steered the ball past the outside of the far post.
In the second half Uruguay's substitute forward Cristhian Stuani steered a header wide of the post when he had the goal at his mercy and Villar saved a volley from Cavani.
Paraguay nearly stole victory in added time when Muslera did well, diving to his right to push a shot from defender Bruno Valdez out for a corner.
"Unfortunately a loss of concentration cost us. I liked the team, we created the best chances," said Gimenez.
(Writing by Rex Gowar, editing by Tony Jimenez)
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