Once service invoice line items are submitted for processing, they must be validated to make sure that the service delivery has been authorized by the organization. This is done by:
- validating that the client(s), provider and payee specified on the line item are registered with the organization.
- validating that the case specified is a valid case.
- validating that the service invoice line item is not a duplicate.
- validating that the provider is approved to deliver the service.
- finding a service authorization for the client(s) that contains a schedule of service delivery which matches with the information specified on the service invoice line item. For example, where a service invoice line item is received for three physiotherapy sessions, there must be corresponding service authorization line item for physiotherapy sessions for that client, on which at least three sessions remain (i.e. have not been previously billed and paid for).
If a single service invoice line item has been submitted for more than one client, all the clients must be present on the same authorization that matches with the service invoice line item. If there are additional clients on the service authorization, they are not considered when matching and validating this invoice line item.
If a service invoice line item fails the matching or validation process, a task is created in the service invoice exception processing work queue stating the reason why the service invoice line item could not be processed. The service invoice line item remains in an 'Open' state until it is modified and resubmitted by the authorized user. This can be done from the exception processing task where the user can modify and resubmit the line item for processing, or deny the line item. The service invoice line item can also be modified and resubmitted directly from the user's workspace. Once resubmitted, the service invoice line item goes through the process of matching and validation again, and if successful, the task is closed.
During the processing of a service invoice line item, if it is found that a flat-rate contract exists for the provider for the period being invoiced, the line item processing stops. This is done in order to prevent any double payments to the provider, as the provider should be paid as per the terms dictated in the flat-rate contract.