When a resident's level of care (LOC) changes, their billing may need to change with it. This guide covers the two best ways to process an LOC charge change: from the resident profile or in the Billing Center.
About LOC Charge Changes
A level of care change is typically triggered by a clinical event. During an evaluation or assessment, a resident's acuity may increase enough to move them into a new level of care, which often carries additional cost.
That clinical decision happens in the Care module when the Service Plan is completed. The billing team's job is to translate it into the right recurring charge on the resident's account, effective on the correct date.
LOC Changes & the Impact Review
This guide references Impact Review, a Billing feature that shows how a mid-period change, such as a LOC adjustment affects invoices that have already been generated, so you can reconcile the difference before it posts. Impact Review must be enabled in Billing Settings. If it is not enabled, the review prompts described below will not appear, and you may need to create or update invoices manually.
ALIS currently offers two versions of Impact Review:
- Standard Impact Review – the established version, and the version this guide covers.
- Enhanced Impact Review – a redesigned version currently in limited release.
For more information about the enhanced version, contact your Account Manager.
Where Charges and Credits Go in the Impact Review
The Impact Review prorates the affected amounts and lets you choose where each resulting charge or credit goes. Depending on whether the line is a charge or a credit and on the timing of the change, you can direct each line to one of the following destinations:
- Unapplied Credits (credits only): leave the credit on the resident's account to allocate later.
- Next Generated Invoice: attach the charge or credit to the next invoice scheduled to generate (not one that has already generated), so it applies automatically when that invoice runs.
- Create New Invoice: generate an invoice immediately, useful when you send invoices on demand or generate invoices manually.
- Unpaid Invoice: apply the charge or credit to an invoice that is already open, adjusting its balance.
Billing Day of the Month
The Billing Day of the Month (the day your invoices generate), set in Billing Settings, determines which options appear and which one ALIS proposes.
The timing of your change relative to that day is what drives the options you see:
- Unapplied Credits is the fallback for a credit, holding it on the account until the next invoice generates.
- Next Generated Invoice appears when an upcoming invoice has not generated yet for the change to attach to.
- Create New Invoice is offered when there is no existing invoice to attach the amount to, or when you bill on demand.
- Unpaid Invoice appears when an open, already-generated invoice exists.
⚠️ Communicate balance changes on invoices already sent if you apply a charge or credit to an invoice that has already gone out to a resident or family, the balance in ALIS will no longer match what they were originally billed. When this happens, let them know the invoice is changing so the new balance is not a surprise.
How billing staff learn about an LOC change
There are two ways your team can catch and process an LOC change. Which one you use depends on your community's operational setup and how ALIS is configured for you.
- ALIS Alert + resident profile: an alert notifies billing staff when a Service Plan is completed, and you make the charge change manually on the resident profile.
- Billing Center: a billing event is generated automatically when a Service Plan is completed, and you process the change through a guided workflow.
Use whichever method matches your community's practices. Both produce the same result: an ended charge for the old level of care and a new charge for the new one.
Method 1: ALIS Alert + Resident Profile
Use this method if your community relies on ALIS Alerts to notify billing staff of care changes rather than the Billing Center.
Step 1: Set up the alert for billing staff
Set up an alert so the billing office is notified whenever a Service Plan is completed.
- Open Alert settings and customize (or edit) an alert for your billing office staff.
- In the alert category, Evaluation and Service Plan, enable the alert event to Service Plan Completed.
- The alert will appear in via their alert preference (Real-Time Email, Daily Digest, SMS Text, Alert Center).
Example Real-Time Email Alert:
For more details on configuring, assigning, and managing alerts, see Alerts Settings and How to Manage ALIS Alerts.
Step 2: End the old level-of-care charge
When you receive the alert, go to the resident's profile > Recurring Charges section.
- Locate the charge for the resident's current (old) level of care.
- Click Options > End Service.
- Enter the Service End Date. Set this date to the day before the new rate takes effect.
- Click End Service.
Step 3: Complete the End Service Impact Review (if applicable)
If enabled, the Impact Review opens with a prorated credit calculated from the Service End Date, for the portion already invoiced at the old rate. How you handle the credit depends on your community's billing practices, the timing of the change, and whether there are unpaid invoices.
- Confirm the credit amount and the dates it covers (the days already invoiced at the old rate after the Service End Date).
Choose where to apply the credit. The available destinations depend on your Billing Day of the Month (see Where Charges and Credits Go in the Impact Review above). How you handle the credit depends on your community's billing practices, the timing of the change, and whether there are unpaid invoices.
- Click Submit.
Step 4: Add the new level-of-care charge
Add a new recurring charge for the resident's new level of care.
- Click +Add Recurring Charge.
- In the pane that opens, select the Payer Type, Payer, and Billing Item.
- Set the Service Start date to the effective date of the LOC change so billing picks up the new rate on the correct day. ALIS will prorate the charge automatically based on that start date.
- Click Submit.
Step 5: Complete the Add Recurring Charge Impact Review (if applicable)
If the new charge starts mid-period, the Impact Review opens so you can place the prorated charge on an invoice.
- Review the charge. Confirm the prorated amount and the dates it covers (from the Service Start date through the end of the current period).
- Set the Action to Add Charge.
- Choose where the charge goes (Next Generated, Create New Invoice, Unpaid Invoices).
- Click Submit.
When Using the Billing Center
Use this method if your community processes care and occupancy changes through the Billing Center. Instead of an alert, ALIS creates a billing event you resolve in a guided workflow.
Before you start
Two things must be in place before LOC events will appear:
- The Billing Center is enabled. This sits behind an entitlement, so contact the ALIS team if you don't see the Billing Center.
- The "Service Plan Completed" event is turned on. This is the event that generates a billing task when a Service Plan is completed. Enable it in your Billing Center settings. See Billing Center Settings.
Step 1: Locate the event and click Process
In the Billing Center, locate the "Service Plan Completed" event for the resident and click Process.
This opens the Billing Event Summary modal where you will complete the following steps 2-5.
Step 2: Review the level-of-care change
Confirm the care change the event is based on. If you need to verify the details, open the linked Service Plan to see the resident's new level of care.
Step 3: Review the recurring charges
ALIS proposes the charge changes for you: it ends the old level-of-care charge and starts the new one.
Double-check the End Service and Start Service dates. They should reflect the effective date of the LOC change: the old charge should end the day before the new level takes effect, and the new charge should start on that date.
Step 4: Review the Impact Review
The Impact Review shows how the change affects the resident's balance and lets you decide where each resulting charge and credit goes. Each line shows the billing impact (the affected period and daily rate), the amount, whether it is a charge or a credit, and the destination ALIS proposes under the To column.
Review each line. To change where a charge or credit goes, click the edit (pencil) icon and choose a different destination. The options available for each line depend on your Billing Day of the Month (see Where Charges and Credits Go in the Impact Review above).
Step 5: Submit
Click Submit to process the change. The ended charge and the new recurring charge will now appear on the resident's profile, and the Billing Center event is resolved.
Related Articles:
- Alerts Settings
- How to Manage ALIS Alerts
- Billing Center Reference Guide
- Billing Center Settings
- Impact Review Reference Guide - coming soon!