Private Pay Agency Setup

Private Pay lets you provide service to clients without the need to be enrolled in state programs. This topic will review the Agency setup. You will add Service Codes and prepare a Service Agreement so that services can be provided. For information about Client setup, see Private Pay Client Setup.

Billing is through invoices. You can accept payment electronically via credit card using Financials > Payments.

This Private Pay feature is not intended for DSS or ADC Attendance Services. Please use the DSS Private Pay for those Service Lines.

To add Private Pay as a Payor:

  1. Go to Administration > Agency > Agency Information.

  2. Click the Edit button at the top of the page.

  3. Under UMPI/NPI & FEIN Information:

    1. Select the State.

    2. Enter PRIVATEPAY in the Agency UMPI/NPI field.

    3. Leave the HHA Agency ID field blank – this is used for Skilled Services

    4. Enter the Federal Tax ID or FEIN for your agency

    5. Enter a Start Date.

    6. Leave the End Date blank.

    7. Select State Provider Identifier for the Provider Type.

    8. Click the Add button, and then click theUpdate button at the top of the page.

  4. Go to Administration > Agency > Manage Service Lines.

    1. Click the + Add Service Line button.

    2. The Add Service Line panel opens. Select Private Pay from the Service Line dropdown.

    3. Enter an Effective Date.

    4. Select Post Payroll Billing from the Parameters Name dropdown, and leave the Parameters Value of No.

    5. Click Add.

    6. Repeat steps a-e if applicable. Click Save.

  5. Go to Administration > Agency > Manage Payors.

    1. Click the Add Payor button.

    2. Select the Payor State from the dropdown.

    3. Select the correct PPay-[State] from Payor dropdown.

    4. Leave the Use Alternate Agency Address set to No.

    5. Click Save.

  6. Go to Administration > Agency > Service Associations.

    1. Click the Add button.

    2. Select Private Pay from the Service Line dropdown.

    3. Select PPAY-[State] – 1:1 from the Service Definition dropdown.

    4. Select the Agency UMPI/NPI.

    5. Select Private Pay as the Payor.

    6. Select Payor Provider Number as the Provider Type.

    7. Enter the Provider Number.

  7. Go to Administration > Agency > Map Tags.

    1. Click the Add/Edit button.

    2. Select Private Pay-Private Pay-1:1 as the Service Definition.

    3. Select the applicable items from the remaining dropdowns and click the Add button.

    4. Click the Save button.

We have added a few service codes to get you started, however you can add your own.

To add your own Service Codes:

  1. Go to Administration > Masters > Private Pay Service Code.

  2. Click the + Add Service Code button.

  3. The Add Service Code panel opens.

    1. Enter a Service Code.

    2. Select the State.

    3. Select the Role.

    4. Select the Allocation Ratio.

    5. Is this rate the same for all Clients? If so, select Yes under Fixed Rate. If not, select No and you is able to enter a different rate for each Service Agreement.

    6. Enter a Description for the Service Code.

    7. Enter the Effective Date.

    8. Select the applicable Service Parameters, at minimum add:

      • Unit of Measure
      • Gross Rate
      • Default Rate

  4. Click Save.

Pavillio is configured to generate invoices automatically on a monthly basis for all Clients. If your Agency as a whole would like to change this to be weekly or bi-weekly:

  1. Go to Administration > Masters > Configuration.

  2. Search for Invoice Generation Period.

  3. Click the Edit icon under the Actions column, and then select a different time period under Value.

  4. Click Update.

If a Client requires a variation from the selected configuration, this can be defined in the Client's Service Agreement in the Invoicing Details section.