Co-contribution is a type of payor program that allows a single bill-to party (the guarantor) to cover 100% of a client’s services while another party (the payor on a contract or the same payor as the guarantor) pays a contribution on a set frequency and any selected premiums.
In co-contribution, the set of rules added to a program is referred to as a contract. The rules determine how much and how frequent the payor’s contribution will be. Only one contract can be added to a co-contribution payor program. However, you can add multiple versions of the contract to the program with different effective dates.
You can also set a limit on how much the payor can contribute over a specific frequency on the contract. For example, the payor might have a contribution of $40 per day with a limit of $200 per week. Once the limit is reached, the remaining amount will be billed to the guarantor.
On the master invoice screen and AlayaCare standard invoice, payor contributions will be displayed as miscellaneous charges of type automatic.
Creating a long-term care insurance payor program for a client
Payor programs are set up at the client level.
You must be in a role configured with the View payor program and Manage payor program ACLs in settings>roles and permissions to view, add, and edit payor programs for clients.
To add a new program, go to Accounting>Payor programs on the client’s profile and select +Add program.
In the Add payor program dialogue, enter the Name of the payor program and select Co-Contribution as the type.
Select a client individual or funder individual funder as the Guarantor. If a client individual-type funder is selected, you will also need to select a Billing contact.
Check the box next to Apply taxes to guarantor if you wish to apply the taxes set at the bill code level to items billed to the guarantor. Note that you will only see this field if taxes have been enabled for this program type in your environment by your AlayaCare client services team.
Finally, select a Billing frequency for the program. In payor invoicing, the billing periods are determined by the billing frequency. The available frequencies are 1 week, 2 weeks, 4 weeks, and Calendar month. When you have finished, click Save.
The program will open as a new screen. Select Edit to make changes to the program details.
To add a contact to the program, select +Add contract.
In the Add Contract dialogue, select a payor from the enabled client individual and funder individual-type funders available to your branch.
Select whether you wish to apply taxes to the payor’s contribution and enter the Contract Number, Coverage Start Date, Coverage End Date, Reference Number, Claim Number, and Contract Details if necessary.
Use the Apply Taxes checkbox if you wish to apply taxes set at the bill code level to items covered by this contract.
Under Contract Rules, enter a Description of the payor’s contribution. Note that if the description field is left empty, the service name associated with the visit will appear in its place on the invoice.
Enter the amount of the contribution and select the frequency at which the amount will be contributed (Per Hour, Per Day, Per Visit). Select a GL revenue account and enter a Cost centre if applicable.
In the Limit section, select Amount as the limit Type. The limit will impose a cap on the total amount that the payor can be charged over a certain frequency. Enter the limit Amount and select a limit Frequency (Per Day, Per Week, Per Calendar Month, Per Calendar Year, or Per Benefit Year).
If you select Per Week as the frequency, you will also need to select the day on which the week should begin.
If you select Per Benefit Year as the frequency, you also need to select the month and day on which the benefit year should begin.
Select Create zero dollar contributions after the limit is reached if you wish to display $0 contributions on invoices once the contribution limit set on the contract is reached. Note that you will only see this option if it has been enabled for your environment by your AlayaCare services team.
In the Taxes field, one or more taxes that you wish to apply to the contract.
If the cost of any premiums will be 100% covered by the payor on the contract, select the applicable premiums in the Select Premiums field.
When you have finished with the contract, click Save.
Once a contract has been created, the Add contract button will be disabled. To edit the contract, select Edit.
If invoices have not yet been generated for this version of the contract (or if any generated invoices have been voided or deleted), you will be able to edit all fields on the contract.
To add a new version of the contract, select Add version.
In the Add version dialogue, enter an Effective Date that the changes should go into effect. You can adjust the contribution description, amount, frequency, GL revenue account, and cost centre (if applicable) as well as the limit amount and frequency. You can also add or remove any taxes or premiums from the contract.
When you have finished entering the version details, click Save.
Note that you can only edit or delete the most version of the contract. Previous versions cannot be edited or deleted.