If you need to bill more than one payor for a client’s services and premiums, you can create a payor program on the client’s profile. A payor program allows you to create a series of rules at the client level for determining which payors are invoiced for what portion of a client's billable items in a billing period.
Each payor program for a client contains a set of informational fields and benefit rules referred to as a policy or contract, depending on the type. The benefit rules determine how much will be billed to the payor on the policy/contract.
You can create different versions of the benefit rules on a policy or contract with different effective dates or start and end dates. The dates of different policy/contract versions cannot overlap with one another.
The payor on the policy or contract is the bill-to party who will be invoiced for a portion of the billable items dictated by the rule set on the policy/contract. The guarantor is the bill-to party who will be invoiced for the remainder of the invoice balances after the program rules have been applied to the billable items.
After you have created your payor program, you must attach it to any client services or billing premiums for which the rules on the program should apply. When adding a program to a service or client billing premium, you must also select a rating funder. This rating funder will use the associated bill codes to determine the rates that will be used to bill for the service or premium during the invoice generation process.
Once items are approved and you begin the invoice generation process, the system will apply the rules on the payor program using the rates associated with the rating funder and generate the invoices for the different bill-to parties.
What types of payor programs are available?
There are different types of payor programs. The type determines the kinds of rules you can set to determine how to split an invoice during the billing process. The type that you select for a payor program will dictate which rule fields and informational fields will be available for completion when adding a policy or contract to a client’s profile.
The following types of payor programs are available to enable upon request:
The table below provides an overview of the major differences between the types of payor programs currently available in AlayaCare:
Long-term care insurance
To learn how to set up a payor program for multi-payor billing, select a program type below:
- Configuring long-term care insurance payor programs
- Configuring co-payment payor programs
- Configuring split percentage payor programs
- Configuring co-contribution payor programs
After configuring a payor program, you will need to attach it to a service or billing premium. To learn more, see Setting a funder methodology for a service or a client billing premium.