Couples_Care_Intake_Scheduling_Billing.txt

Couples Care Intake, Scheduling and Billing Process
Purpose: 
To ensure Couples Care households using Long Term Care Insurance (LTCI) are set up, verified, scheduled, and billed correctly, treat each insured individual as a separate claim while maintaining coordinated service delivery for the household.
Key Rule (Most Important): Couples Care always requires two client profiles when both individuals are receiving care-regardless of payer type.
Each spouse is treated separately for:
* care plan
* scheduling
* documentation
* billing allocation

Step 1 - Intake
At intake confirm:
* Is this a Couples Care? If yes, it will require 2 separate leads in order to create 2 client accounts and opportunities- this is handled by the LHA team.
* Coverage type: No LTCI, One spouse insured, Both spouses insured

Step 2 - Client Setup
* Create two client profiles (one per prospect/client). This is created when both opportunities are created and then linked.
* Each profile must contain the correct insurance details.

Step 3 - Assessment & Care Plan
* A single CSM can assess the couple together.
* Document separate care plans for each spouse.
* Ensure care hours are individually allocated.

Step 4 - Scheduling
* Schedule shifts for each client separately.
* Caregivers may serve both clients in the same home.
* Time tracking must reflect actual time per client.

Step 5 - Billing
* Invoice each spouse separately based on their coverage.
* LTCI claims must be filed per individual policy.
* Track shared vs. individual caregiver hours.