Release date: August 24, 2026
Version: 1.0
Audience: Ruh Core Team
What is new
The Billing area brings program setup, client coverage, appointment billing, and billing-status tracking into one place.
Teams can now:
create and manage Direct Billing (DB) and Special Program (SP) programs;
add coverage for clients who are already on the platform;
record approval for clients who are not yet on the platform;
track each appointment through a program-specific billing flow;
review unlinked clients and connect them to a platform account later; and
schedule coverage additions or updates for a future date.
Important: Direct Billing is a program type inside Billing. It is not a separate page.
Quick start
Open Care Hub and select Billing.
Open Programs and create the Direct Billing or Special Program.
Open Clients and select Add Coverage.
Search for the client by email and complete the coverage details.
Use Appointments to review and update billing statuses.
Key terms
Direct Billing (DB): Ruh bills another organization or payer for eligible sessions.
Special Program (SP): A program that covers all or part of a client's eligible sessions.
Coverage: A client's approval for a specific program.
Platform Client: A client with an existing Ruh Care platform account.
Unlinked Client: A client whose coverage approval is recorded before they have a platform account.
Primary coverage: The program used first for coverage.
Secondary coverage: An additional program used in addition to the primary program.
Programs Tab
Add a program
When we need to add a new program
Add a program when a new payer, employer, partner, or internal coverage arrangement needs its own rules in Care Hub. Typical cases:
a new Direct Billing payer or billing partner goes live;
a new Special Program starts (employer, grant, or funded sessions);
an existing arrangement needs a separate sub-organization, currency, claim due-date rule, or billing-status flow; or
Canada (Ruh Corp.) or US (Ruh Care Inc.) coverage needs its own statuses, limits, or claim rules tracked in Care Hub.
Do not create a duplicate program only to change one client's sessions or dates — use Add Coverage or Update Coverage on the Clients tab instead.
You need the Create Program permission to complete this task.
Before creating the program
Use a clear program name that the team will recognize.
Confirm the sub-organization carefully; it controls the entity and currency used for coverage.
Keep the billing flow short. Add a status only when the team needs to take or record a distinct action.
If a custom field label already exists in another program, its field type and options may be shared across programs. For example, UCI number can be a custom field that can be used across more than one program.
How to add a program
Open Billing.
Select the Programs tab.
Select Add Program.
Enter the program name.
Choose the type of program Special Program or Direct Billing.
Select the sub-organization:
Ruh Care Inc. for US programs and charged in USD;
Ruh Corp. for Rest of the world programs and charged in CAD.
If needed, choose the platform tag that should be applied when a platform client receives coverage. (optional)
Review the Billing Status Flow and select the default billing status.
For Direct Billing, set the Claim Submission Due Date:
Fixed for one specific due date; or
Relative for a number of days after the appointment.
Once the claim submission due date passes, and if the appointment hasn't reached a billing status end state(s), the appointment will be flagged for payment discrepancy.
Add any coverage limits, expiry defaults, copay settings, custom fields, or late cancellation settings required by the program.
Select Create Program.
Edit a program
You need the Edit Program permission to edit and the Archive Program permission to archive.
When do you update a program
Update a program when the arrangement itself changes for everyone on that program. Typical cases:
rename the program so the team recognizes the current payer or partner;
change the default billing status or allowed status transitions;
adjust claim submission due dates (fixed or relative);
update coverage limits, expiry defaults, copay defaults, custom fields, or late-cancellation settings; or
change the optional platform tag applied when a client receives coverage.
Prefer editing the existing program over creating a new one when the payer and sub-organization stay the same.
When do you mark a program as Inactive
Archive (inactivate) a program when it should no longer be used for new coverage. Typical cases:
the partner contract or funding period has ended;
the team has replaced it with a new program (new rules, entity, or payer); or
the program was created in error and must not appear for new enrollments.
Archiving does not remove historical coverage or appointment billing records. Confirm with billing ops before archiving if clients still have active coverage on the program.
How to edit the program
Open the Programs tab.
Select the program from the list.
Select Edit Program.
Update the required settings.
Select Update Program.
To stop using a program, open its action menu and select Archive. Archived programs are inactive and should not be used for new coverage.
Check before saving: Program changes can affect the choices team see when working with appointments. Confirm the default billing status and allowed status transitions after editing the billing flow.
Clients Tab
Add coverage
You need the Enroll Client permission.
When to add coverage
Add coverage when a client is approved to use a Direct Billing or Special Program arrangement. Typical cases:
a platform client is newly approved for a program;
an approval must be recorded before the client has a platform account (Unlinked Client);
primary coverage already exists and the client needs a secondary program; or
coverage details (sessions, dates, copay, or custom fields) must be recorded or refreshed for an existing approval.
If the change should take effect later, use Schedule an approval or update instead of saving immediately.
How to add coverage
Open the Clients or Unlinked Clients tab.
Select Add Coverage.
Enter the client's email address and select Search.
If a client platform account is found, select that, in case it doesn't you can enter the details of the client and link it later. In that case, the approval is saved as an Unlinked Client until a platform account is available.
If the client already has primary coverage. You can update the current coverage; or turn on Add as Secondary Program to add additional coverage.
Enter the copay type - amount or percentage.
Enter the number of approved sessions. Leave it blank when there is no session cap.
Enter the approval and expiry dates. The expiry date is required and must be in the future.
Complete notes and any program-specific fields.
Select Add Coverage.
How to link an Unlinked Client Account Coverage to a Platform Account
By default, the client's new platform account will link automatically after account creation if the platform account name and email exactly match the unlinked client's name and email.
If it does not, use the manual steps below.
Open Unlinked Clients Tab.
Select the client.
Search for the platform account by email, or enter the Platform Client ID.
Confirm the entity.
Select Link to Platform.
Schedule an approval or update
Use scheduling when coverage should take effect or be updated later.
Complete the Add Coverage, Update Coverage, or client-update form.
Open the menu beside the main save button.
Choose the scheduling option.
Select a future date and, if needed, a time.
Confirm the schedule.
Review scheduled work in the Scheduled tab. A pending action can be cancelled. Completed, failed, and cancelled actions remain visible for tracking.
Appointments Tab
Edit appointment details
Disclaimer: Only members with permission to update appointments can perform this action.
Use the appointment panel when billing, program, or session details for a single appointment need correction.
How to edit an appointment
Open the Appointments tab.
Select the appointment row to open the edit panel.
Use the tabs as needed:
Program — program, coverage status, sessions, copay, coverage amounts, notes, reporting and expiry dates;
Billing — billing type, billing status, claim submitted / paid dates, and fully-paid flag;
Session — CPT, diagnosis, duration, and session start / end times;
Activity — recent changes for audit context.
Update the fields that need correction.
Save the appointment.
Changing billing status here follows the same rules as Use billing statuses below. Select a program before the billing-status field is available.
Related billing operations
These processes describe how billing ops work alongside Care Hub. Sub-organizations:
Ruh Care Inc. = US (USD)
Ruh Corp. = Rest of world (CAD)
Billing statuses (legacy names → Care Hub)
The billing status already used in the system are mapped to some new statuses in Care Hub. Older labels (including third-party / Canada billing language such as Billing Headway or another billing DB) map to the Care Hub program billing-status flow as follows:
Legacy / current ops label | Care Hub billing status |
To-Bill | Submit Claim |
Billed | Claim Submitted |
Free Session/Supervision | Select the program as Internal write off |
Paid | Payment Received |
Written off | Change the program name to Internal Write-off |
Other labels that may still appear in ops lists (for example No Condition Match, Not Billed, Not Found, Paid On Platform, Written off - Billing Period Expired) should be handled per team practice and, when a Care Hub equivalent exists, updated on the appointment's Billing Status.
When configuring a program's billing-status flow, prefer the Care Hub names in the right-hand column so Appointments and payment-discrepancy work use the same vocabulary.
Write off and Fit Guarantee
Write-offs and Fit Guarantee are recorded by assigning the appointment to a dedicated program, not by adding a new billing status.
For a write-off:
Open the appointment and go to the Program tab in the sidebar.
Change the program to Ruh Internal Write-offs USD or Ruh Internal Write-offs CAD, matching the sub-organization currency (Ruh Care Inc. = USD; Ruh Corp. = CAD).
Select the program to attach it to the appointment.
Add the write-off amount in the Coverage Charged field.
Add the amount that the client has paid, in Copay charged if its a partial write-off.
Set the appropriate billing status in the Billing tab.
Save the appointment.
For Fit Guarantee:
Open the appointment and go to the Program tab.
Change the program to Fit Guarantee USD or Fit Guarantee CAD.
Select the program to attach it to the appointment.
Add the write-off amount in the Coverage Charged field.
Add the amount that the client has paid, in Copay charged if its a partial write-off.
Set the appropriate billing status in the Billing tab.
Save the appointment.
Payment discrepancy filters (Coming Soon)
These are filters for payment discrepancies queues for appointments or invoices that need CCT review. A common path:
Open Final Invoice Review for cases that remain unpaid after 45 days and after reminders.
Use Review Billing DB/SP-Client when Direct Billing or Special Program coverage may explain or change the outcome.
Payment discrepancy filter actions include:
Filter / action | When to use it |
3rd Party Not Reimbursed | Third-party claim or reimbursement did not come through |
Appointment Date Passed - Status Not Set | Appointment date has passed but billing status was never set |
DB/SP Client Charged Full Amount | A Direct Billing or Special Program client was charged the full session amount |
Final Invoice Review | Still unpaid after 45 days and reminders |
Insurance Paid - Change Invoice Status | Insurance paid; invoice status must be updated |
Invoice Not Found | Expected invoice is missing |
Process Direct Billing / Special Program | Appointment should move through the DB/SP Care Hub billing flow |
Review Billing DB/SP-Client | Confirm coverage and billing treatment for a DB/SP client |
Special Program Info Missing | Special Program details are incomplete for billing |
After resolving a discrepancy, update the appointment Billing Type and Billing Status in Care Hub so the queue and Care Hub stay consistent.
Use billing statuses
Billing statuses show what the billing team needs to do next for an appointment. Each program can have its own labels and allowed transitions. Legacy ops names (To-Bill, Billed, Paid, and so on) map to these Care Hub statuses.
Special Programs vs Direct Billing: Custom billing statuses can be set for Direct Billing (DB) programs only. Special Program (SP) appointments have a billing status of Not Applicable by default and do not use the custom billing-status flow.
The default flow is:
Session Pending — wait for the session to become billable.
Submit Claim (legacy: To-Bill) — the claim needs to be prepared and sent.
Claim Submitted (legacy: Billed) — the claim has been sent and is awaiting an outcome.
Record the outcome:
Payment Received (legacy: Paid) when payment is complete;
Partially Paid when only part of the claim was paid;
Claim Declined when the payer rejects the claim;
No Payment Required (legacy: Free Session/Supervision) when no claim or collection is needed.
From Claim Declined, return to Submit Claim when the claim will be corrected and resubmitted.
From Partially Paid, move to Payment Received or Written Off.
Update an appointment's billing status
Open the Appointments tab.
Select the appointment or its billing-status badge.
Open the Billing tab in the appointment panel.
Confirm the Billing Type.
Select the next Billing Status.
Add the claim-submitted date, claim-paid date, or fully-paid value when applicable in case of Direct Billing.
Save the appointment.
The status menu normally shows only the current status and the next steps configured for that program. If no status has been selected, it shows the starting status.
Notes:
To see all statuses, simply choose the final billing status.
If the billing-status field is unavailable, select a program for the appointment first.
Use Direct Billing
Direct Billing uses the same coverage and appointment workflow as Special Programs, with payer-claim details added.
Create or select a program with Program Type: Direct Billing.
Configure its claim due-date rule and billing-status flow.
Add coverage to the client.
Confirm the client's coverage is active, not expired, and has sessions remaining when a session cap applies.
After an eligible appointment occurs, review it in Appointments.
Confirm the billing type is Direct Billing.
Move the appointment through the program's billing statuses as the claim is submitted and resolved.
When an eligible payment request is processed for an Occurred appointment, the billing process records insurance/direct billing and uses a write-off reason tied to the Direct Billing program. Any client copay remains the client's responsibility.
Understand the three status types
Coverage Status answers: “Can this client still use the program?” The current values are Active and Expired.
Billing Type answers: “Who is expected to pay?” The choices are Self-Pay, Special Program, and Direct Billing.
Billing Status answers: “Where is this appointment in the billing process?” These statuses are configured per program.
Changing an appointment's billing status does not extend expired coverage or add approved sessions.
Helpful tabs
Programs: Create, edit, and archive program definitions.
Clients: Review platform and off-platform coverage records.
Appointments: Manage appointment billing and claim progress.
Unlinked Clients: Find approvals that are waiting for a platform account.
Client Summary: Review a client's session totals.
Scheduled: Review future approvals and updates.
Important internal notes
A platform client can have primary and secondary coverage. Verify the program before editing a row.
Sessions used are system-maintained for platform coverage and should not be treated as a manual tally.
Off-platform clients do not enter the platform appointment workflow until they are linked.
A coverage approval does not invite or create a platform client.
Use the activity history and Scheduled tab when confirming who changed or scheduled an item.
Direct Billing and Special Programs share the same workspace, but their billing types and write-off reasons differ.
Current limitations
Do not rely on the following as active automation unless the development team confirms that it has been enabled:
session-reminder settings configured on a program;
superbill email notification settings configured on a program;
automated program-specific late-cancellation policy processing;
automatic enforcement of the program-level maximum coverage amount;
Care Hub resolution of client profile mismatch between platform profiles and billing records (see Process 1).
Billing-status transitions are guided by the interface, but staff should still confirm that the selected status reflects the real claim outcome.
Troubleshooting
The client cannot be found
Check the email spelling and entity. If the client does not have a platform account, continue with the Unlinked Client path.
The billing status cannot be changed
Confirm that a program is selected and that the program has a billing-status flow.
The expected next status is missing
Review the program's configured status transitions. An administrator may need to edit the program.
An unlinked client did not link automatically
Open Unlinked Clients and link the correct platform account manually.
Coverage is not available for a session
Confirm that coverage is Active, the expiry date has not passed, approved sessions remain when capped, and the correct primary or secondary program is attached.
Before you finish
Confirm the client and entity.
Confirm the program and primary or secondary coverage.
Confirm the copay and approved sessions.
Confirm the expiry date.
Confirm the appointment's billing type and status.
Add notes when another team member will need context.
Support
For access, configuration, or unexpected billing behavior, contact [email protected] and include the client ID, program name, appointment ID when applicable, and a short description. Do not include sensitive client information in unsecured channels.