Treatment Plan Lifecycle: Pre-Authorization to Payment
The complete end-to-end journey of a treatment plan — from a victim requesting ongoing treatment through pre-authorization, session-based approval, service billing, and payment in VCPOffice.
Step-by-Step Guide • 2026Table of Contents
- Lifecycle Overview & State Diagram
- Treatment Plan vs. Expense Bill
- The Four-Stage Financial Flow
- Part 1: Creating the Treatment Plan (VCPOnline)
- Prerequisites & Navigation
- Treatment Plan Form Fields
- Financial & Session Fields
- Validation & Submission
- Post-Submission — Tracking Status
- Part 2: Processing the Treatment Plan (VCPOffice)
- Receipt & Queue Assignment
- Treatment Plan Management Interface
- Section 1: Treatment Plan Details
- Section 2: Approvals & Adjustments (Award Items)
- Auto-Approval & Pre-Authorization
- Award Item State Machine
- Section 3: Completed Services (Service Bills)
- Service Bill State Machine
- Section 4: Payment Items
- About Panel & Financial Summary
- Session & Financial Balance Calculations
- Resolution: Completed or Withdrawn
- Estimate Tracking & Renewal
- Cross-Portal Visibility
- Key Features & Capabilities
1. Lifecycle Overview & State Diagram
A treatment plan represents a pre-authorized request for ongoing treatment — typically mental health counseling, physical therapy, or other session-based services. Unlike an expense bill (which reimburses a past expense), a treatment plan is forward-looking: the victim requests approval for a series of sessions before the services are fully delivered.
Each treatment plan follows a defined lifecycle defined by the RequestedBenefitState enum — 12 states shared across all requested-benefit types (Treatment Plan, Expense Bill, Income Loss).
Treatment Plan State Diagram
| State | Code | Description | Portal |
|---|---|---|---|
| Draft | 0 | Treatment plan is being created. Can be edited and submitted. | VCPOnline / VCPOffice |
| Intake | 10 | Submitted and queued for initial intake review. | VCPOffice |
| Pending Review | 15 | Awaiting analyst assignment or prerequisite information. | VCPOffice |
| Under Review | 25 | Analyst actively reviewing the treatment plan and provider documentation. | VCPOffice |
| Pending Determination | 30 | Review complete; awaiting director / supervisor determination. | VCPOffice |
| Pending Board Determination | 40 | Referred to board (when program requires board review at the requested amount). | VCPOffice |
| Approved | 100 | Treatment plan approved. Award items may be created for sessions and amounts. | VCPOffice |
| Determined | 110 | Final approved session count / amount determined. Service bills are processed as providers bill the sessions. | VCPOffice |
| Processed | 120 | All approved sessions serviced and paid. Terminal success state. | VCPOffice |
| Denied | 200 | Treatment plan denied. Reason code required. Terminal state. | VCPOffice |
| Rescinded | 210 | Previously-approved plan rescinded (e.g., after ineligibility discovered). | VCPOffice |
| Withdrawn | 300 | Treatment plan withdrawn. Can be reopened if needed. | VCPOffice |
2. Treatment Plan vs. Expense Bill
Both treatment plans and expense bills are "requested benefits" that share the same base entity and state machine. However, they serve fundamentally different purposes and have different processing workflows.
| Feature | Treatment Plan | Expense Bill |
|---|---|---|
| Purpose | Pre-authorize ongoing treatment (future services) | Reimburse a past expense (already incurred) |
| Session Tracking | Tracks number of sessions (requested, approved, serviced, paid) | No session tracking |
| Estimate Mode | Enabled by default — amounts are projections until final bills arrive | Disabled by default — amounts represent actual costs |
| Service Bills | First service bill created automatically; multiple bills expected over time | Usually a single bill for the expense |
| Typical Categories | Mental Health, Medical (therapy), Physical Therapy | Funeral, Relocation, Crime Scene Cleanup, Medical (one-time) |
| Duration | Spans weeks/months (ongoing treatment period) | Single event or short period |
| ShortName Format | TP-2026-0001 | EB-2026-0001 |
| Financial Tracking | Four stages: Requested → Approved → Serviced → Paid (with sessions at each stage) | Three stages: Considered → Approved → Paid |
3. The Four-Stage Financial Flow
Treatment plans track finances and sessions through four distinct stages. Understanding this flow is essential for both victims and staff.
The victim requests a number of sessions and estimated cost.
Example: 50 sessions, $5,000 total cost, $500 insurance = $4,500 requested.
Staff creates award items to formally approve sessions and amounts. Auto-approval may apply if a pre-authorization exists.
Example: 45 sessions approved for $4,050.
As the provider delivers sessions, service bills are created to record actual services rendered and costs billed.
Example: 20 sessions completed, $1,800 billed.
Payments are issued for completed service bills. Payment items link to a Payment and a Payment Batch for disbursement.
Example: 15 sessions paid, $1,350 disbursed.
Part 1: Creating the Treatment Plan (VCPOnline)
Victims or claimants use the VCPOnline portal to request treatment plan approval. The treatment plan captures the type of treatment, provider, estimated number of sessions, and projected cost.
Prerequisites & Navigation
Before creating a treatment plan, the following prerequisites must be met:
Active Claim
The victim must have an existing VcClaim in an active state (Intake or later). Treatment plans cannot be created for Draft claims.
Logged In to VCPOnline
The victim must be authenticated in the VCPOnline portal with their account linked to the claim.
How to Navigate
Navigate to the VCPOnline portal and log in with your account credentials.
From the dashboard, click on your active compensation claim to open the claim detail view.
Click the Treatment Plans tab on the claim management page. This shows all existing treatment plans and provides the option to create a new one.
Click the New Treatment Plan button to open the treatment plan creation form.
Treatment Plan Form Fields
The treatment plan creation form collects core information about the requested treatment. The form is a single-page form (not a multi-step wizard).
| Field | Type | Required | Notes |
|---|---|---|---|
| Benefit Category | Dropdown | Yes | Select the type of treatment (Mental Health, Medical, etc.). Categories are configured by program administrators. |
| Service Provider | Lookup | Yes | The provider who will perform the treatment (therapist, clinic, hospital). Can search existing registered providers. |
| Counselor Name | Text | No | Name of the individual counselor or therapist. Commonly used for Mental Health benefit category. |
| Service Date From | Date | Yes | Start date of the proposed treatment period. |
| Service Date To | Date | Yes | Projected end date of the treatment period. Can span weeks or months. |
| Number of Sessions | Numeric | No | Total number of treatment sessions being requested (e.g., 20, 50). This is a key tracking field for session-based treatment. |
| Service Details | Textarea | No | Description of the treatment being requested. Provide enough detail for staff to evaluate the request. |
Financial & Session Fields
The financial section captures the estimated cost of the full treatment plan and any third-party coverage.
| Field | Type | Required | Notes |
|---|---|---|---|
| Total Cost Amount | Currency | Yes | Estimated total cost of all requested sessions. For example, 50 sessions at $100/session = $5,000. |
| Insurance Amount | Currency | No | Amount expected to be covered by insurance. Defaults to 0. |
| Percent to Pay | Percentage | No | Percentage of the remaining amount (after insurance) the program should cover. Defaults to 100%. Shown conditionally based on benefit category configuration. |
| Patient Prepaid | Currency | No | Amount the victim has already paid or will pay out-of-pocket. Defaults to 0. |
Automatic Calculations
Requested Amount
Total Cost − Insurance
The net amount being requested from the program.
Amount to Cover
(Total Cost − Insurance) × Percent to Pay / 100
Maximum amount the program may pay.
Amount Billed
(Total Cost − Insurance) − Patient Prepaid
Net billing to the program after all deductions.
50 sessions requested | Total Cost: $5,000 | Insurance: $500 | Percent to Pay: 100% | Patient Prepaid: $0
Requested Amount = $5,000 − $500 = $4,500
Amount to Cover = $4,500 × 100% = $4,500
Cost per Session = $5,000 / 50 = $100/session
Validation & Submission
Validation Rules
| Rule | Description |
|---|---|
| Required Fields | Benefit Category, Service Provider, Service Date From, Service Date To, and Total Cost Amount must be provided. |
| Date Validation | Service Date From must not be after Service Date To. Treatment period dates must be reasonable. |
| Financial Validation | Total Cost must be greater than zero. Insurance Amount cannot exceed Total Cost. |
| Duplicate Detection | The system checks for potential duplicates based on provider, date range, benefit category, counselor name, and number of sessions. Matching is warn-only (does not block submission). |
| Claim State Check | The parent claim must be in an active state that allows treatment plan submission. |
Submission Flow
After completing the form, click the Submit button.
All required fields, dates, and financial data are validated. Duplicate detection runs and displays warnings if potential matches are found.
A unique identifier (e.g., TP-2026-0001) is automatically generated using the program's configured number sequence.
The system automatically creates an initial Service Bill linked to the treatment plan. This service bill is set to Intake state and mirrors the treatment plan's financial data.
The treatment plan moves to Intake state and appears in the VCPOffice queue for staff review, then advances through Pending Review / Under Review / Pending Determination as analysts work on it.
Configured notifications are triggered. The assigned claims examiner receives an alert, and the victim may receive a confirmation message.
Post-Submission — Tracking Status
After submission, the victim can track the treatment plan's progress through VCPOnline with read-only access.
Status Visibility
The treatment plan's current state (Intake, Under Review, Approved, Determined, Processed, Denied, Rescinded, Withdrawn, etc.) is displayed on the claim's Treatment Plans tab. The victim sees a simplified, read-only view of their treatment plan.
Limited View
VCPOnline shows only safe, victim-appropriate data. Internal processing details (staff notes, approval routing, financial balances) are not visible to the victim.
Notification Updates
The victim receives notifications when approvals are completed or payments issued through the program's configured channels (email, SecMail).
Payment Tracking
When payments are issued for the treatment plan, the victim can see payment dates, amounts, and payment methods in VCPOnline.
Part 2: Processing the Treatment Plan (VCPOffice)
When a treatment plan is submitted from VCPOnline (or created directly by staff), it enters the VCPOffice workflow. Staff uses the Treatment Plan management interface to review the request, create approval decisions (award items), track service delivery through service bills, and issue payments.
Receipt & Queue Assignment
When a treatment plan transitions out of Draft into Intake, it is automatically routed based on the program's workflow configuration.
The system detects the new submission and creates the work item in VCPOffice. The parent claim's assigned examiner is typically notified.
Based on WorkItemManagerConfig rules, the treatment plan may be auto-assigned to the same examiner handling the parent claim, or routed to a specialized treatment plan review queue.
The treatment plan appears in the staff member's work queue and on search screens. It can also be found through the parent claim's Treatment Plans tab.
Treatment Plan Management Interface
The VCPOffice Treatment Plan management screen uses the ManageWorkItemBase layout pattern with a summary panel and a split edit/about area.
Summary Panel (Left)
Displays the treatment plan's ShortName (TP-YYYY-####), current state badge, benefit category, service provider, total cost, amount to cover, service date range, and action buttons (Submit, Change State).
Edit Panel (Center)
Contains 4 major sections arranged vertically: Treatment Plan Details, Approvals & Adjustments, Completed Services (Service Bills), and Payment Items. Staff works through these sections top-to-bottom as they process the plan.
About Panel (Right)
Shows claim financial summary, related documents, activity history, and the parent claim's ownership chain. Provides context for processing decisions.
Section 1: Treatment Plan Details
The first section displays and allows editing of the core treatment plan information.
| Field | Staff Access | Description |
|---|---|---|
| Service Details | View / Edit | Description of the treatment being provided. Staff can add notes or clarifications. |
| Counselor Name | View / Edit | Individual counselor or therapist name. |
| Service Date From / To | View / Edit | Treatment period dates. Staff can adjust based on provider documentation. |
| Number of Sessions | View / Edit | Total sessions requested. Staff can adjust based on clinical recommendations. |
| Total Cost Amount | View / Edit | Total estimated cost. Updates per-session cost calculation. |
| Insurance Amount | View / Edit | Insurance coverage amount. |
| Percent to Pay | View / Edit | Program payment percentage. Shown conditionally based on benefit category. |
Section 2: Approvals & Adjustments (Award Items)
The Approvals & Adjustments section is the core of treatment plan processing. Staff creates award items to formally approve sessions and amounts for the treatment plan.
Three Types of Award Items
Award Item (Approval)
The standard approval decision. Specifies the number of sessions and dollar amount being approved for payment.
- Links to a parent Award on the claim
- Sets sessions for approval
- Sets amount for approval
- Routes through approval workflow
Approval Adjustment
Reduces previously approved amounts or sessions. Used when circumstances change (e.g., victim discontinues treatment early).
- References the original award item
- Negative amount/sessions
- Includes a reason for adjustment
- Subject to its own approval routing
Quick Approval
An expedited approval path for straightforward requests that meet pre-authorization criteria.
- Simplified approval flow
- Auto-approved if within limits
- Same financial tracking
- Faster turnaround
Award Item Grid
All award items are displayed in a grid within this section:
| Column | Description |
|---|---|
| Requested Date | Date the award item was created. |
| Type | AwardItem, ApprovalAdjustment, or QuickApproval. |
| State | Current state of the award item (Draft, Waiting for Approval, Completed, Voided). |
| Considered (Amount / Sessions) | Amount and sessions being considered for this approval. |
| For Approval (Amount / Sessions) | Amount and sessions submitted for approval decision. |
| Approved (Amount / Sessions) | Final approved amount and sessions (populated when Completed). |
The section footer displays the Total Approved Amount and Total Approved Sessions across all completed award items.
Auto-Approval & Pre-Authorization
VCPMS supports automatic approval of award items when a pre-authorization (pre-approval) exists for the claim and benefit category combination.
How Auto-Approval Works
An administrator or supervisor has created an AwardPreapproval record for the claim's benefit category with a pre-approved dollar amount.
Staff creates an award item and submits it to Waiting for Approval state.
The system checks if the requested amount fits within the remaining pre-authorization balance:
Remaining Balance = Pre-Approved Amount − Sum of Previously Approved Items
If the amount is within the remaining balance, the award item is automatically approved — AmountApproved is set, and the state transitions directly to Completed with a comment noting auto-approval. If the amount exceeds the balance, manual approval is required.
Remaining balance: $10,000 − $4,000 = $6,000. Since $3,000 ≤ $6,000, the award item is auto-approved.
Award Item State Machine
Each award item follows its own state machine within the treatment plan:
| State | Code | Description |
|---|---|---|
| Draft | 0 | Award item created but not yet submitted. Staff can edit amount and session counts. |
| Waiting for Award | 10 | Linked to a parent award that is being processed. |
| Waiting for Approval | 15 | Submitted for approval. Auto-approval check runs. If not auto-approved, waits for manual approval. |
| Completed | 20 | Approved. AmountApproved and NumberOfSessionsApproved are set. Funds can be disbursed. |
| Voided | 30 | Award item cancelled. Does not count toward approved totals. |
Section 3: Completed Services (Service Bills)
Service bills track the actual delivery of treatment sessions. As the provider delivers sessions and submits bills, staff records the completed services.
Single vs. Multiple Service Bill Mode
Single Service Bill (Default)
For treatment plans with a single billing period. The automatically-created service bill is displayed inline with an embedded edit form. Staff updates the financial details directly.
Multiple Service Bills
For treatment plans spanning multiple billing periods. Staff can add additional service bills using the "Add ServiceBill" button. Each bill tracks a separate set of sessions and costs.
Service Bill Fields
| Field | Description |
|---|---|
| Service Date From / To | Actual dates the sessions were delivered. |
| Number of Sessions | Actual number of sessions delivered in this billing period. |
| Total Cost Amount | Actual cost billed by the provider for these sessions. |
| Insurance Amount | Insurance coverage for these sessions. |
| Percent to Pay | Program payment percentage. |
| Service Details | Description of services actually rendered. |
| State | Service bill state (Draft, Intake, Approved, Determined, Processed, Denied, Rescinded, Withdrawn). |
The section footer displays the Total Serviced Amount and Total Serviced Sessions across all service bills.
Service Bill State Machine
Each service bill follows its own state machine:
| State | Code | Description | Transition Conditions |
|---|---|---|---|
| Draft | 0 | Service bill created but not yet submitted. | Submit to move to Intake. |
| Intake | 10 | Service bill submitted; staff is reviewing. Can be edited and deleted. This is the initial state for auto-created service bills. | Can advance to Approved only if the treatment plan has at least one approved award item (AmountApproved > 0). |
| Approved | 100 | Service bill approved against an award item on the parent treatment plan. | Continues toward Determined once the final amount is set. |
| Determined | 110 | Final billed amount determined. Payment items can be created against this service bill. | Advances to Processed when payments are processed. |
| Processed | 120 | Payments disbursed. Terminal success state. | — |
| Denied | 200 | Service bill denied. | Terminal. |
| Rescinded | 210 | Previously-approved service bill rescinded. | Terminal. |
| Withdrawn | 300 | Service bill withdrawn without processing. | Terminal. |
Section 4: Payment Items
The Payment Items section manages the actual disbursement of funds. Payment items are created after service bills are completed and award items are approved.
Payment Header
At the top of this section, the Payable Balance is prominently displayed:
Payable Balance = Total Approved Amount − Total Paid Amount
This tells staff exactly how much can still be paid out for this treatment plan.
Payment Creation Flow
At least one award item is in Completed state, and at least one service bill is in Completed state. The payable balance is greater than zero.
Staff clicks the Add Payment Item button. The form pre-fills with the payable balance amount and the configured payee.
Enter or confirm the payment amount, payee, number of sessions being paid for, and date of service. The payment is linked to a specific service bill.
The payment item is linked to a Payment work item which goes through two-level authorization (preparer creates, authorizer approves).
Authorized payments are added to a Payment Batch for bulk processing. The batch produces paper checks and Excel/CSV exports for upload to the state financial system. (NACHA/ACH direct export is on the roadmap.)
Once the batch is processed, the payment is marked as completed. The treatment plan's financial summary updates — Total Paid and Payable Balance reflect the disbursement.
Payment Items Grid
| Column | Description |
|---|---|
| Requested On | Date the payment item was created. |
| Payee | Who receives the payment (provider, victim, or other). |
| Date of Service | Service date range for the sessions being paid. |
| Reference | Payment reference number. |
| Payment | Link to the parent Payment work item (clickable to view payment details). |
| Amount | Dollar amount of this payment item. |
| Sessions | Number of sessions this payment covers. |
The section footer displays the Total Paid Amount and Total Paid Sessions.
About Panel & Financial Summary
The right-side About Panel provides reference information and the claim-level financial context.
| Tab / Section | Description |
|---|---|
| Claim Financial Summary | Shows the parent VcClaim's overall financial picture — total across all expense bills and treatment plans. Helps staff understand the claim-level budget context. |
| Originated Document | If the treatment plan originated from a document intake, shows a preview of the source document. |
| Activities | Timeline of all activities performed on this treatment plan — state changes, edits, approvals, assignments. |
| Out Documents | System-generated documents (approval letters, authorization notices). |
| Log | Complete audit log with field-level change tracking. |
Session & Financial Balance Calculations
The system tracks both dollar amounts and session counts at every stage. These calculations appear in the financial summary and guide staff through the processing workflow.
| Calculation | Amount Formula | Sessions Formula | Purpose |
|---|---|---|---|
| Requested | Total Cost − Insurance | Number of Sessions (from treatment plan) | What the victim originally requested. |
| Considered | Sum of AwardItems.AmountConsidered | Sum of AwardItems.SessionsConsidered | Total amount/sessions in award items (including pending). |
| Available to Consider | Requested − Considered | Requested Sessions − Considered Sessions | Remaining amount/sessions that can still have award items created. |
| Approved | Sum of Completed AwardItems.AmountApproved | Sum of Completed AwardItems.SessionsApproved | Formally approved for payment (including adjustments). |
| Approved Balance | Approved − Paid | Approved Sessions − Paid Sessions | Approved but not yet paid. This is the payable balance. |
| Serviced | Sum of ServiceBills.TotalCostAmount | Sum of ServiceBills.NumberOfSessions | Services actually delivered and billed by the provider. |
| Paid | Sum of Completed PaymentItems.Amount | Sum of Completed PaymentItems.Sessions | Funds actually disbursed. |
| Stage | Sessions | Amount |
|---|---|---|
| Requested | 50 | $4,500 |
| Approved | 45 | $4,050 |
| Serviced | 20 | $1,800 |
| Paid | 15 | $1,350 |
| Payable Balance | 30 | $2,700 |
Resolution: Processed or Withdrawn
A treatment plan reaches its final state when all treatment has been delivered and paid (Processed), or when the plan is denied or withdrawn.
Processed
The treatment plan reaches Processed (the terminal success state) when:
- All approved award items have been disbursed
- All service bills have been serviced and paid
- All payments have been issued
- No further treatment sessions are expected
Before advancing to Processed, service bills must reach their own Determined/Processed state so payment items can finalize.
Withdrawn
The treatment plan is Withdrawn when:
- The victim discontinues treatment
- Submitted in error or duplicated
- Parent claim is withdrawn or denied
Withdrawal conditions: the treatment plan must have an originated document and no non-draft award items. If award items have been issued, they must be voided first.
End-to-End Summary
Estimate Tracking & Renewal
Treatment plans have estimate tracking enabled by default. This recognizes that treatment plan costs are projections — the actual cost depends on how many sessions are ultimately delivered.
Estimate Mode
When estimate tracking is active, the treatment plan records:
- Estimate Date — when the estimate was submitted
- Estimate Expiration Date — when the estimate expires and must be renewed
- Financial amounts are treated as projected until finalized
Renewal / Extension
When a treatment plan's estimate expires or additional sessions are needed:
- Staff can update the treatment plan with new dates and session counts
- Additional award items can be created for the new sessions
- Additional service bills track the new billing period
- Alternatively, a new treatment plan can be created for the same claim
Cross-Portal Visibility
Treatment plan data flows across VCPMS portals with appropriate access controls.
| Portal | Access Level | What Users See |
|---|---|---|
| VCPOnline | Read-only (safe fields only) | Treatment plan status, approved sessions, payment status. No internal processing details. Cannot edit after submission. |
| VCPOffice | Full Access | Complete management interface with all 4 edit sections, financial tracking, service bills, and payment processing. |
| VCPProvider | Read (linked plans) | Service providers can see treatment plans linked to their services, payment status, and approved session counts. |
| VCPAdvocate | Read (assigned claims) | Advocates can view treatment plans for claims they are assigned to, including status and session tracking. |
Key Features & Capabilities
Session-Based Tracking
Track sessions through every stage: requested, approved, serviced, and paid. Session counts appear alongside dollar amounts throughout the interface.
Pre-Authorization & Auto-Approval
Set up pre-authorization amounts per claim and benefit category. Award items within the pre-approved balance are automatically approved, reducing manual processing.
Estimate-to-Actual Conversion
Treatment plans start as estimates and transition to actual costs as service bills are completed. The system tracks both projected and confirmed amounts.
Multiple Service Bills
Support for multiple billing periods within a single treatment plan. Providers submit bills as sessions are delivered over weeks or months.
Approval Adjustments
Reduce or adjust previously approved amounts without creating negative payments. Approval adjustments maintain a clear audit trail of all changes.
Duplicate Detection
Warn-mode detection based on provider, dates, category, counselor name, and session count. Prevents accidental duplicate treatment plan submissions.
Integrated Payment Pipeline
Payments flow from approved award items through service bill completion to payment batches with two-level authorization and multiple disbursement methods.
Complete Audit Trail
Every action is logged — from initial submission through final payment. Field-level change tracking records who changed what and when, across all child entities.
Related Documentation
Claim Lifecycle
Understand the full claim lifecycle from application through resolution. Treatment plans are created within the context of an active claim.
Expense Bill Lifecycle
Compare with expense bills — the other requested benefit type. Expense bills handle one-time past expenses rather than ongoing treatment.
VCPOffice Guide
Comprehensive guide to the staff back-office, including all claim processing workflows and financial management capabilities.