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Setting Up Member Benefits

CareAdminBillingUpdated Jul 26, 2026

Overview

The Benefits tab records each member's funding sources and the details needed to bill for them. A benefit ties the member to a benefit type (configured for your center), a schedule, usage limits, and — when the benefit type generates claims — the claim details such as authorization numbers and ICD-10 codes.

This article covers adding a benefit, setting its schedule and limits, entering claim codes and ICD-10, and editing or deactivating a benefit.

Before You Begin

  • You must be logged in with Admin or Billing permissions.
  • The member must already exist.
  • Your center's benefit types must be configured first — the Benefit Type dropdown lists your center's active benefit types (there is no free-text funding source).
  • The Claim Codes section (including ICD-10) appears only when Billing is enabled for your center and the selected benefit type generates claims.

Steps

Step 1: Open the Benefits tab

  1. Select Care > Members and open the member.
  2. In the profile tabs, open the Services group and select Benefits.

Benefits tab in the Services group

Step 2: Add a benefit and choose the Benefit Type

  1. Select Add Benefit.
  2. Choose the member (pre-filled) and select a Benefit Type from the dropdown. This list comes from your center's active benefit types.

Add Benefit form with the Benefit Type dropdown open

Step 3: Set the schedule

  1. Under Dates, set the Start Date (required) and, if the benefit ends, the End Date.
  2. Under Days, select the days of the week this benefit applies to.
  3. Turn on Allow benefit on non-scheduled days if the member may use this benefit on days they are not normally scheduled.

Benefit schedule with dates and days

Step 4: Set hours, limits, and billing options

  1. Enter Required Hours per Day if the benefit requires a minimum daily attendance.
  2. Choose a Limit Type: No Limit, Days per Week, Days per Month, or Total Days. When you choose anything other than No Limit, enter the number in Limit Days.
  3. Turn on Transportation Billing to bill transportation together with attendance.
  4. Enter a Billing ID if this benefit uses one.

Hours, Limit Type, and billing options

Step 5: Enter claim codes and ICD-10

If Billing is enabled and the benefit type generates claims, a Claim Codes section appears. ICD-10 lives here, as part of the member's benefit authorization — not on the clinical Diagnoses & Conditions tab.

  1. Enter the Insurance Member ID and Group Number if the payer requires them.
  2. Enter the ICD-10 Primary code. This is the primary diagnosis code sent on claims for this benefit.
  3. If the benefit type has charge codes, enter per-charge-code values under ICD-10 Charge Codes to override the primary code for specific charge codes.
  4. Enter the Prior Authorization Number (and any per-claim-group prior authorization numbers) if required.
  5. If a Claim Codes Requirements warning appears, fill in the listed fields before you bill.

Claim Codes section showing the ICD-10 Primary field

Step 6: Set the status and save

  1. Set the Status to Active, Pending, or Inactive.
  2. Select Save. The benefit appears on the Benefits table, where the ICD-10 Primary column shows the code you entered.

Screenshot coming soon — Saved benefit listed on the Benefits table with the ICD-10 Primary column

Step 7: Edit or deactivate a benefit

  1. On the Benefits table, select the benefit to reopen the form.
  2. Update any field, or set the Status to Inactive (or set an End Date) to stop using the benefit while keeping its history.
  3. For claim-generating benefits, you can run Check Eligibility from the form; the recency policy comes from the benefit type. Select Save to apply changes.

Editing a benefit and running an eligibility check

Tips

  • ICD-10 is a billing field, not a diagnosis record. Enter it under the benefit's Claim Codes. The Diagnoses & Conditions tab is clinical and does not feed claims.
  • Use ICD-10 Charge Codes for exceptions. Set the ICD-10 Primary once, then override only the specific charge codes that need a different code.
  • Deactivate instead of deleting. Setting a benefit to Inactive (or adding an End Date) preserves billing history for audits.
  • Watch for the Claim Codes Requirements warning. It lists exactly which claim fields are missing before you can bill or check eligibility.
  • Add benefits during intake so billing can begin as soon as the member starts attending.

Troubleshooting

Problem Solution
The Benefit Type I need is not listed Benefit types are configured at the center level. Ask your administrator to add or activate the benefit type.
There is no Claim Codes / ICD-10 section Claim Codes appear only when Billing is enabled for your center and the selected benefit type generates claims. Non-claim benefit types do not show it.
The benefit will not save Start Date and Benefit Type are required. Numeric fields (hours, limit days) must be numbers, and Limit Days must fit the chosen Limit Type range.
The ICD-10 Primary column is empty on the table Reopen the benefit and enter a value in the ICD-10 Primary field, then save.
The eligibility check button is disabled Resolve the items listed in the Claim Codes Requirements warning first.