Services provided directly to the client by the agency use standard product delivery processing to determine eligibility and issue payments to the client or other participant for the service. Services provided by a third party provider can be paid for in one of the following ways: using service invoices, using attendance rosters or using flat rate contracts. If payment for the service is based on receipt of a service invoice or attendance roster, the service can either use CPM processing or product delivery processing to issue the payments to the provider, depending on whether the payment amount is based on a custom rate. If payments are based on a custom rate that can change over time, product delivery processing is used to calculate the payment amount and upon receipt of an invoice or roster, issue the payments. If payments are not based on a custom rate, i.e., they are based on a fixed rate, CPM processing is used to issue the payments for the service. CPM processing is also used where payment is based on a flat rate contract.
If eligibility is determined for a service, a service authorization and one or many service authorization line items are automatically created if the client is determined eligible. For services where eligibility is not determined, the service authorization is created after service approval. Each service authorization line item represents a specific date or date range within which the client is authorized to receive the service, as well as the number of units that are authorized. The service authorization line item may also contain a specific provider or provider type from which the participant is authorized to receive the service.
Before a payment can be issued, a service authorization is required for services that are paid for based on receipt of a service invoice or attendance roster. Services where payment is based on flat rate contracts, do not require a service authorization in order to be paid. Case workers can view eligibility decisions and determinations in respect of a service for a client in the same way that they are viewed for product delivery cases. For more information on viewing eligibility decisions, see Reading Decisions, Eligibility, Entitlement, and Explanation. For detailed information on CPM financial processing and configuring services for delivery, see the Cúram Provider Management Guide.