When setting up the system, begin by adding your payers and service codes. Once those are in place, you can move on to creating budgets for your clients.
Adding payers
The Payer Management section is where you create all the entities (payers) your agency bills to. These may include state medicaid programs, county-specific programs, or private payers.
When you run reports or audit billing, each service will be tied to a payer. Accurate payer setup ensures that reports reflect the correct billing and reimbursement data.
To add a payer:
Click Finance in the left menu
Click Payer Management in the left menu
Click Create Payer
Fill in the required fields
Name
Description
Click Save
Repeat this process to add all entities you bill to. This must be done before creating service codes or adding client budgets.
Adding service or billing codes
Service codes are the foundation of your billing and scheduling system. They represent the services your agency is approved to provide and what your agency bills for each client.
Setting these up correctly ensures accurate reimbursement and reporting.
To add a billing code:
Click Finance in the left menu
Click Code Management in the left menu
Click Create Billing Code
Fill in the required information
Basic Info:
Code Name: enter the code name as listed in Medicaid or the billing entity (e.g., T2003)
Modifiers
Display Name: this is the name displayed for the DSPs (e.g., Respite Level One)
Group Code
Code Details:
State
Place of Service
Description
EVV Required: skip this unless the code requires EVV
Billing Configuration:
Split at Midnight: decide if you want to separate overnight shifts at midnight
Unit Type: select Minutes, Day, or Distance
Enable rounding: if toggled on, enter Minutes worked to round up
Rate: e.g., $15.50
Click Save Code
Repeat for all codes your agency uses. This must be done before adding client budgets.
Adding client budgets
Once the payers and service codes are created, budgets can be added for each client.
To add a budget:
Click Clients in the left menu
Search for the client and click Profile
Click Budget in the slide-out menu
Click Create Budget +
Fill in the required fields:
Service Code (i.e. billing code)
Payer (i.e. entity billed for services)
Available Units
Rate: default rate populates once Service Code is selected, but rate can be individually changed on the client level
Start Date and End Date
Reference ID (e.g., Authorization number, PCP number, or another state identifier)
Restrictions
Click Save
See Client Profile: Budget for additional information.
For questions or support:
Contact your Customer Success Manager
Or email: [email protected]