Shows how the state benefits system works.
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State/county decides to hire contractors to offer services to clients rather than offer those services directly.
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State/county enters into contracts with limited number of contractors (clients can not hire other contractors and have their costs counted by the state as a covered expense).
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State/county offers and signs contracts with contractors stating, rates, etc.
Contractors select which counties they wish to serve (contractors NOT required to serve entire state).
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State/county requires all invoicing to be controlled by state. Reason: Only the state knows the amount each client has allocated for monthly spend down.
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Contractors do work for individual clients under the state/county contract.
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State/county directs contractor to invoice full amount of invoice to client. State pays $0.00.
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NO
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If spend down balance <= invoiced amount, contractor told to invoice balance of spend down to client, with remainder of contractor's invoice paid by state/county. Client balance for this month now = $0.00.
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NO
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Is client's remaining spend down for the month (month of service on invoice) = $0.00?
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State/county knows remaining balance of spend down allocated to each client by month.
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Contractors send invoices to state/county for each service provided to state clients.
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YES
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YES
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YES
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Contractor sends invoice to client.
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YES
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State/county lists amount to be billed to client spend down on client EOMB for this invoice and tells contractor to directly bill this amount to client.
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State/county lists cost of service in EOMB. EOMB shows "State Paid" full amount. Amount to be paid by client is $0.00.
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YES
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Client sorts new invoices received and compares them to EOMB. Either the amounts match or they do not
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YES
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Invoice goes into "to be paid" file sorted by month.
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YES
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Is total of invoices received for any month = spend down amount for that month?
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YES
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Pay all invoices for the month(s) in which invoices received = spend down amount for that month.
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Month closed because all spend down invoices have been paid.
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NO
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NO
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Problem with EOMB or invoice. To be resolved by state/contractor. Notify state/county to get correct amount in writing.
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Hold remaining spend down invoices because they are all partial months.
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Systemflow
