Organizations assess client needs and authorize providers to provide services to address those needs. A service authorization is the instrument through which the organization authorizes a provider to provide specific services to a specific client in return for payment. The period during which the service must be delivered is also specified in the authorization.
Service authorizations contain line items (called service authorization line items). Each line item represents a schedule for a specific service for a certain number of units within a specific period. A provider may or may not be specified on the line item. If a provider isn't specified, clients can avail of the service from any registered provider.
An example of this process is as follows: Robert Smith is in need of support to help regain employment. Robert's caseworker recognizes a need for him to take up a training course to help achieve that outcome. The caseworker creates an outcome plan for Robert, and adds the Language Skills service, a training course, to take place over 3 months from 1st January to 31st March with a total of 60 hours duration. The caseworker also records the details of a local training provider from whom Robert needs to take up the course. The caseworker then approves the outcome plan, at which point a service authorization is automatically created for Robert. On the service authorization a line item is created with the service Language Skills, a from date of 1st January, a to date of 31st March and units authorized of 60.
A provider can be paid for the number of units of a service delivered to a client, limited to the number of units specified on the service authorization line item for the client. The delivery of those units is tracked through the invoices or rosters submitted by the provider. Payments against flat-rate contracts are independent of service delivery, and hence service authorizations are not considered when making such payments.
A service authorization can contain multiple clients, which means all the clients are eligible to receive the number of authorized units. The provider will be paid for the entire service delivery and not on per client basis. For example, if two clients are authorized on a single authorization to receive 10 sessions of a counseling service between the 1st and 15th of a month, then they are eligible to receive 10 sessions in total between them, each of which could be attended by one, the other or both clients. If they have received all 10 sessions together, the provider will be paid for 10 sessions and not for 20 sessions.
Service authorization line items may also contain nominee details where the payment is to be received by someone else other than the provider.
The lifecycle of a service authorization is as follows:
| Status | Description |
|---|---|
| Open | A service authorization has a derived state of 'Open' if the derived state of all of its service authorization line items is 'Open'. |
| In Progress | A service authorization has a derived state of 'In Progress' if at least one service authorization line item has a status of 'Open' or 'In Progress', but not all service authorization line items have a status of 'Open'. |
| Complete | A service authorization has a derived state of 'Complete' if the derived state of all of its service authorization line items is 'Complete'. |
| Canceled | A service authorization has a status of 'Canceled' if the service authorization has been deleted. |
The lifecycle of a service authorization line item is as follows:
| Status | Description |
|---|---|
| Open | A service authorization line item has a derived state of 'Open' if no service invoice line items or roster line items have yet been matched against the service authorization line item. |
| In Progress | A service authorization line item has a derived state of 'In Progress' if it has been matched to at least one service invoice line item or roster line item, all the units remaining on it are not consumed yet, and it has not already ended (i.e. it has a 'To' date in the past). |
| Complete | A service authorization line item has a derived state of 'Complete' if all the units on it are consumed or it has ended (i.e. it has a 'To' date in the past). |
| Canceled | A service authorization line item has a status of 'Canceled' if the service authorization line item is canceled or deleted. |