The authorization process starts at the back end of the system, in the Admin settings>Scheduling>DDM-Scheduling>Service Type.

You need to create a separate service type for each serivce you provide for which you charge a different rate.  Personal Care--Private Pay; Personal Care--Medicaid; Personal Care--VA; Personal Care XYZ Insurance, etc.

Once the service types have been created, you can configure them for HOW you bill and pay by going to the Admin Settings>Scheduling>Service Type.

By clicking on the Edit icon in the action column, you can indicate exactly how you bill and pay for each type of service.

The most common fields to change are the default bill units (Medicaid frequently bills in 15-minute increments) and the Type (Personal or Respite)

Your Service Types are created and configured.  Now you need to set the default rates that you will bill your clients/their payers for each type of service.

To do this, you need to go to Office Settings>Rates and add the rate for every different Service Type.  Make sure you also add the PAY rate for each service type, unless you pay your caregivers each a unique rate.

Make sure that the start date for the rates goes back as far as your authorization start dates.  Sometimes that means up to a year ago.

Now that your back end settings are done, you need to add your payers, the people who will actually be paying the bill.

Go to Clients>Payers from your main screen.

Add each Payer Company (or private person), making sure to complete the required fields.  

Once you save the Payer, you can go to the Billing tab and add any ICD 10 PCS or Revenue Codes at the bottom of the page

After your payers are all entered in your CareSmartz360 system, you can start associating them with your clients.

Go to Clients>Clients>Open a client profile>Rates Tab and select Add Existing Payer

Use the search tool to find the payer that you have already added to the system, and that will open the Add Client Payer window.

  1. Indicate the order in which this payer will pay (primary means that this payer will get the "first" hours.  Secondary means that someone else pays the first amount, and this payer gets the next portion, etc.

  2. Add the Member ID from the insurance

  3. Select Client Authorization as the Payment Distribution

  4. If the Client is not the actual subscriber to the insurance plan, uncheck this box and add the person who is.

When you select Client Authorization from the drop down, a new window will open for you to add the details of the authorization. If you have any modifiers to the Authorization, you will be able to add them here.

After you save the authorization, you also need to save the payer to the client profile

  • Select, "Medicaid", under the Claim File Indicator Code.

  • Select Bill Type (defaults to Weekly).

  • Click the Save button to save the record, or the Cancel button to cancel the record.

Now, when you create the client schedule, you will select the Service Type and confirm that the Authorization ID shows in the Bill Type Box.

After the schedules have been created, you can see the hours "count" down right on the calendar

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