These are the core steps for creating any Private Pay policy. The process is the same regardless of who is paying. The only difference is which payer you select in Step 3. See the scenarios below for details specific to each type of payer.
Navigate to the Client. Go to Clients, then select the client whose policy you would like to update.
Open the policy builder.
From the Services tab in the Client's profile. The service will automatically be added to the policy.
In the Client's profile, click Services
Click the service you want to add a policy to.
Click Create Policy
You can also go to the client’s Policies tab and click Create Policy.
Keep the Private Pay tab selected. For notes on each Private Pay scenario you could have, click here. The Third Party tab is used for VA and Medicaid policies and is covered in a separate article.
Select the Payer. Choose the person or organization responsible for payment. The payer must already be set up as a payer on their profile.
Optional — Configure Advanced Controls. Open Advanced Controls if you need to add service groups or coverage limits, enter a Policy/Authorization/Claim number, upload documents, or adjust Assign Benefits to Payer. See the LTC/Guide scenario below for information about when to turn this option on.
Confirm the Services and Coverage Start Date. Under Services, review the services covered by the policy. The service you started from might be pre-filled, but you can add additional services if needed. Then set the Coverage Start Date. Assigning a service to the policy is what connects it to the payer for billing.
Optional: If you would like to save this policy as a draft, click the dropdown next to Create Policy and click Save Draft.
Click Create Policy. The services assigned to the policy are now connected to the payer and can be invoiced to them.
Specific Notes on each Private Pay scenario
A. Client pays for their own care
If the client is paying for their own care, select the client as the Payer in Step 3. Invoices will be billed directly to the client using the email, invoice frequency, and payment method listed on the client’s payer profile.
B. A contact pays on the client's behalf
Use this option when a family member or responsible party is paying for the client’s care.
If the contact is not already set up as a payer, create them under Contacts and add their payer information first. Then, select the contact as the Payer in Step 3. Invoices will be addressed to that contact.
The payer’s billing settings and saved payment methods are stored on their contact profile, so the same payer can be used across multiple clients and policies.
C. LTC / Guide organization pays (with reimbursement)
Use this option when a long-term care (LTC) insurer or Guide-type organization is responsible for payment.
Select the organization as the Payer in Step 3.
Then, in Step 5, open Advanced Controls to configure whether the policy is a primary policy or a reimbursement-only policy.
Under Assign Benefits to Payer, choose the appropriate option:
Leave it on (default): Use this for a primary policy. The agency bills the payer directly.
Turn it off: Use this for a reimbursement-only policy. Billing routes to the client’s primary policy instead.
If the client has both a primary policy and a reimbursement policy, Careswitch generates two invoices:
The primary policy has Assign Benefits to Payer turned on, and the client pays the resulting invoice out of pocket.
The reimbursement policy has Assign Benefits to Payer turned off, and a separate reimbursement invoice is sent to the LTC insurer.
Turning off Assign Benefits to Payer is what makes the policy reimbursement-only.
Advanced Controls
Advanced Controls are primarily used for GUIDE and LTC policies, but they can also be helpful in the rare cases where a client has specific care requirements or stipulations that need to be documented. Most clients will not require these additional settings. If needed, you can also use Advanced Controls to add:
Policy Number, Authorization Number, and Claim Number: Enter the information provided by the payer.
Service Groups: Group services that share a coverage limit. For each group, set the Limit Value, Limit Type (hours, visits, or dollars), Limit Period (week, month, year, or authorization), and coverage dates.
Documents: Upload policy-related documents by dragging and dropping them or browsing for a file. The maximum file size is 50 MB per file.
What's Next?
Scheduling: When you schedule a shift for the client, Careswitch will automatically use this policy when the shift’s service matches a service covered by the policy.
Billing: Completed shifts are automatically included on invoices using the service’s bill rate. You can adjust the rate for an individual shift if needed.
Usage Tracking: If the policy includes a coverage limit, Careswitch tracks usage in real time. You can view the current usage on the policy’s detail page.
Common Updates to a Policy
Change the rate: Update the service’s bill rate under Settings → Workspace Services, or adjust the rate on an individual shift. Bill rates are not stored on the policy, so you don't need to update the policy itself.
Add a service: Add another service to the existing policy instead of creating a new policy.
End the policy: Set a Coverage End Date. Shifts that fall within the policy’s coverage period will remain billable.
Stop using the policy without ending it: Archive the policy to keep it for your records while preventing it from being used for new shifts.