Handling Claims with Multiple Budget Allocations and Contributions

Handling Claims with Multiple Budget Allocations and Contributions

Scenario A. Multiple Budget Allocations (No Co-contribution)

QuestionAnswer
How does CareVision handle scenarios where Services Australia returns a claim split across multiple funding categories?CareVision accepts the total amount from the SAH Payment Statement Summary (Services Australia) and reconciles it against the original claim from the SAH Claim File (CareVision). Even if the amount is split across different funding categories, CareVision recognizes that the total matches and marks it as no variance. The split amounts are then reflected in the Invoice and SAH Monthly Statement File.

Example
You deliver a service for 3.3333 hours at $30.00 per hour, totalling $100.00 in the SAH Claim File (CareVision).
In the SAH Payment Statement Summary (Services Australia), the same $100.00 is split into:
  1. Ongoing Support = $60.00
  2. Home Care = $40.00
    (No co-contribution applied)
How It Appears in the Claims Management Dashboard
After uploading the SAH Payment Statement Summary (Services Australia) to CareVision, the dashboard shows:
Reconciliation Status: No variance



How It Appears in the Invoice
The $100.00 is split into two rows in the Invoice:
  1. Ongoing Support = $60.00 
  2. Home Care = $40.00
Note: For Xero Invoices, the Quantity and Unit Amount columns reflect these allocated amounts.

How It Appears in the SAH Monthly Statement File
From the $100.00 total in the SAH Monthly Statement File:
  1. $60.00 appears under detailed expenses
  2. $40.00 is recorded as unspent funds

Scenario B. Multiple Budget Allocations (with Co-contribution)

QuestionAnswer
How does CareVision handle scenarios where Services Australia returns a claim split across multiple funding categories with co-contribution applied?CareVision accepts the total amount from the SAH Payment Statement Summary (Services Australia) and reconciles it against the original claim from the SAH Claim File (CareVision). When co-contribution is applied, CareVision separates the government-funded portion and the participant contribution. If the total matches, the reconciliation status is marked as no variance. The split amounts are then reflected in the Invoice and SAH Monthly Statement File.

Example
You deliver a service for 4 hours at $25.00 per hour, totalling $100.00 in the SAH Claim File (CareVision).
In the SAH Payment Statement Summary (Services Australia), the same $100.00 is split into:
  1. Ongoing Support = $60.00
  2. Home Care = $40.00
  3. Co-contribution = $20.00
How It Appears in the Claims Management Dashboard
After uploading the SAH Payment Statement Summary (Services Australia) to CareVision, the dashboard shows:
Reconciliation Status: No variance

How It Appears in the Invoice
The $100.00 is split into four rows in the Invoice:
  1. Ongoing Support = $50.00
  2. Home Care = $30.00
  3. Ongoing Support co-contribution = $10.00
  4. Home Care co-contribution = $10.00
How It Appears in the SAH Monthly Statement File
From the $100.00 total in the SAH Monthly Statement File:
  1. $60.00 appears under detailed expenses
    (Govt Pay = $50.00, You pay = $10.00)
  1. $40.00 is recorded as unspent funds
    (Govt Pay = $30.00, You pay = $10.00)

Scenario C. Multiple Budget Allocations (with Co-contribution and Variance)

QuestionAnswer
How does CareVision handle scenarios where Services Australia returns a claim split across multiple funding categories, but the total does not match the original claim?CareVision reconciles the returned amounts from the SAH Payment Statement Summary (Services Australia) against the original claim from the SAH Claim File (CareVision). If the returned total is lower than the claimed amount, the difference is recorded as a variance. The reconciliation can still be accepted, and CareVision uses the returned values to generate the Invoice and SAH Monthly Statement File. The unpaid difference is stored as a payment difference for tracking.

Example
You deliver a service for 6 hours at $23.31 per hour, totalling $139.86 in the SAH Claim File (CareVision).
In the SAH Payment Statement Summary (Services Australia), the returned amounts are:
  1. Ongoing Support = $60.00
  2. Home Care = $40.00
  3. Co-contribution = $10.00
  4. Variance = $39.86
How It Appears in the Claims Management Dashboard
After uploading the SAH Payment Statement Summary (Services Australia) to CareVision, the dashboard shows:
Reconciliation Status: Pending - Accepted

How It Appears in the Invoice
The Invoice is split into four rows:
  1. Ongoing Support = $54.00
  2. Home Care = $36.00
  3. Ongoing Support co-contribution = $6.00
  4. Home Care co-contribution = $4.00
How It Appears in the SAH Monthly Statement File
From the returned amounts in the SAH Monthly Statement File:
  1. $60.00 appears under detailed expenses
    (Govt Pay = $54.00, You pay = $6.00)
  1. $40.00 is subtracted from unspent funds
    (Govt Pay = $36.00, You pay = $4.00)
Variance Handling
The unpaid $39.86 is:
  1. Recorded as a payment difference
  2. Not included in the Invoice
  3. Not included in the SAH Monthly Statement File
Keywords: sah claims, carevision reconciliation, services australia payment summary, budget allocation split, home care funding, ongoing support funding, co contribution, sah monthly statement, invoice breakdown, claims management dashboard

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