How do I use Payor Programs?

If you need to bill one or more payors 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.

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. 

This guide will discuss Split Percentage specifically, but Co-Payment and Co-Contribution work similarly. For Long-Term Care Insurance, please refer to our article: How do I set up a client for long-term care insurance?

Split percentage is a type of payor program that allows you to generate invoices for billable items according to the percentages set for each payor on the contract versions currently in effect on the program. Split percentage works well in billing scenarios where various payors are responsible for a fixed percentage of the overall cost of a client’s care.

From the client's profile:

1. Go to Accounting>Payor programs on the client’s profile and select+Add program.
2. Enter the Name (i.e., "Ray's Plan") of the payor program and select Split percentage as the Type 
3. Select a client individual or funder individual funder as the Guarantor outside of coverage. This is the default fall back should the payor defined not pay part or all of the owed amount.
4. If you select a client individual funder, you will also need to select a Billing contact.