Reporting

Capitation

There seems to be a myriad of capitation arrangements these days. That's why we have added multiple capitation methodologies and continue to add more and more each year. Whether you are using a traditional PMPM model, a distributed pool model, or census model we have got you covered. If we don't accommodate a model you are utilizing just let us know. We have structured our capitation pieces so new and exciting cap models can be added quickly and easily.

Feature	Benefits
Calculates capitation for Primary Care Physicians, Specialists and/or other Non-Primary Care Providers	Our flexible Capitation model allows your organization to provide reimbursement to a broad range of provider populations. Allows your organization to carve-out specialty risk pools for Capitation rather than paying Fees-For-Service.
Capitation can be calculated based on patient Primary Care Provider selection and member’s age and gender	Allows your organization to administer Capitation arrangements as they were originally designed: Per Member/Per Month.· Capitation can be calculated for up to 99 user-defined age categories per gender; including monthly categories up to age 3.
Ability to retain date sensitive history for all Capitation rate assignments	Our application will automatically calculate retroactive addition and/or deletion of enrollees along with a multitude of other elements for the prior 3 months and adjust payments accordingly.
Disbursement of frequency based cap payments based on an RVU point value (Pool Cap)	Allows a lump sum cap payment to be dispersed among providers using a Dollar Amount Per RVU Equivalent at a claim service level.

Application Screen Shots
PMPM Capitation Module