DRAFT_Couples_Care_Intake_Scheduling_and_Billing_Process.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.zx

   * 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 flipped to closed/won.  The account should never be manually created in Wellsky.

         * Collect insurance details per insured spouse if applicable
Step 3 — Scheduling & Billing Rules
If neither spouse has LTCI:
            * Maintain two separate client profiles

            * Split the bill rate and scheduled hours between both clients according to the care plan
[a][b]
If only one spouse has LTCI:
               * Schedule insured hours under insured spouse

               * Other spouse billed under their payer type (private pay, etc.)

If both spouses have LTCI:
                  * Split caregiver shift between spouses

                  * Do NOT bill the same hours to both claims

Example:
9am–1pm shift
                     * Client A: 9–11

                     * Client B: 11–1

Step 4 — Documentation
Caregiver notes must reflect:
                        * which client was served

                        * services provided as indicated by ADL/IADL tasks

                        * time spent per client
Common Mistakes to Avoid
                           * Creating only one client profile

                           * Billing the same hours to both spouses

                           * Not splitting shifts when both receive care

                           * Incorrect payer assignment
One-Line Field Reminder:
Couples Care = Two clients, two profiles, and hours allocated separately — regardless of payer type.


[a]@audraw@thekey.com - when splitting rate I know for LTCi clients we spit the rate in two different CCAs. Are we required to always have 2 CCAs in place for reach clients regardless of LTCi? For example couple care rate is $50/hr than we would do one $25.hr and the other client 25/hr
_Assigned to audraw@thekey.com_
[b]I will say, in this aspect, it would be easier for our team when the carrier asks for the CCA so it matches the billing. So if you are splitting the bill rate, then the CCA should be split with each individual name; if you are not, then one rate with both client names on it.