In Careswitch, a service defines the type of care you provide, while a policy connects a payer to that care. Policies can be set up for private pay—such as the client, a family contact, or an LTC/Guide organization—or for a VA third-party authorization.
New to policies? Start with What is a Policy? for the concept overview.
How services and payers connect
The people or organizations who pay for their care are payers. Two key components connect clients and payers:
A service (service line) is the type of care you deliver — e.g., Companion Care or Skilled Nursing. It includes the bill rates and a care plan, but on its own it has no payer.
A policy connects a payer to the client’s care. Each policy belongs to the client, identifies the payer, and includes one or more service groups that specify which services the policy covers and any applicable coverage limits.
The key point: Assigning a service to a policy is what connects that service to its payer. A service that is not covered by a policy cannot be billed to a payer.
Because of this, setting up a client follows two main steps:
Add the service to the client.
Create a policy, select the payer, and assign the service(s) the policy covers.
The type of payer determines which type of policy you create:
Client, contact, or LTC/Guide organization: Create a private-pay policy, select the payer, and assign the services it covers.
VA or similar electronic third-party payer: Create a third-party policy from the authorization. Careswitch uses the authorization to build the policy and its covered services.
Before You Start
Before setting up a service or policy, make sure you have the following:
Client profile: Confirm that the client’s profile has been created.
Payer: If the payer is a family contact or organization (such as an LTC/Guide), make sure they are listed under Contacts so they can be selected when creating the policy. For more information, see Setting Up a Client or Contact as a Payer.
Third-party policy: For VA payors, make sure the client’s date of birth and Veteran ICN are on file. For Medicaid payers, a Medicaid ID is required instead.
Quick reference
Once the payer is set up, the basic process is the same: create a policy, select the payer, and assign the service(s) it covers. The steps vary slightly depending on the type of payer.
Payer | Steps | Notes |
Client (self-pay) | Create Policy → Private Pay → Payer: the client → confirm Services + Coverage Start Date → Create Policy | Billing (email, frequency, payment method) comes from the client's own payer profile. |
Another contact | Set the contact up as a payer → Create Policy → Private Pay → Payer: that contact → confirm Services + Coverage Start Date → Create Policy | Invoices are addressed to the contact. |
LTC / Guide (organization) | Create Policy → Private Pay → Payer: the organization → Advanced Controls → enter policy number & limits → Create Policy | By default, this bills the organization directly. To make it reimbursement-only, uncheck Assign Benefits to Payer — billing then routes to the client's primary policy instead, producing two invoices: one to the client, one reimbursement invoice to the insurer. |
VA (third-party) | Create Policy → Third Party → Payer Type: VA → select Payer → Upload Authorization (SEOC) → Create Policy | Policy stays provisional until the authorization is processed. Careswitch then validates it, pulls the DOB and Veteran ICN, builds the service groups & rules, and notifies you once approved. |