Handling Claims with Underpayment (With Co-Contribution)

Handling Claims with Underpayment (With Co-Contribution)

The system handles claims where the payment is less than the claimed amount and a co-contribution applies.

Question	Answer
How does CareVision handle scenarios where Services Australia returns a claim with a payment less than the claimed amount and a co-contribution applies?	CareVision uses the total amounts returned by Services Australia (both government payment and co-contribution) as the values reflected in the invoice and statement. Any difference from the original claimed amount is recorded as a variance. The Quantity column in the invoice is recalculated to represent the service hours corresponding to each payment component.

Example

You deliver a service for 2 hours at $16.58 per hour, totalling $33.16 in the SAH Claim File (CareVision).

In the SAH Payment Statement Summary (Services Australia), the payment is recorded as:

1. Budget Drawdown: $30.00
   
2. Co-Contribution: $5.00
   

(Variance of $3.16)

How It Appears in the Claims Management Dashboard

After uploading the SAH Payment Statement Summary (Services Australia) to CareVision, the dashboard shows:
Reconciliation Status: Accepted

How It Appears in the Invoice

The payment is shown as two rows:

1.5078 hours x $16.58 = $25.00

0.3016 hours x $16.58 = $5.00

Note: Calculated values in the Invoice may display up to 5 decimal places. These values are rounded up to 2 decimal places in the SAH Monthly Statement File.

How It Appears in the SAH Monthly Statement File

The statement shows the same amount as the invoice:

1.8094 hours x $16.58 = $30.00

1. Govt Pay = $25.00
   
2. You Pay = $5.00
   

For more information, see Support at Home Billing and Claiming Workflow.