SOLUTIONS SPOTLIGHT: HEALTHCARE BENEFITS ANALYTICS FOR SELF-FUNDED EMPLOYERS LEARN MORE
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Automated, End-to-End Capitation Adjudication

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Time to eliminate manual management of capitated payments and fee-for-service components. This user-friendly, complete solution delivers a purpose-built suite of tools that administer any payment model with ease—from contract configuration and eligibility management through adjudication and payment.

Say goodbye to overhead costs and hello to streamlined workflows with:

  • Robust electronic data interchange (EDI) capabilities
  • Support for standard and proprietary data formats
  • Continuity between existing systems and the partner ecosystem
  • Self-service functionality and easy configuration
  • Single-platform claims processing, provider payment, and contract management

 

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Client Success Story

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You set the goal. We make it happen.

An independent physician association (IPA) client faced a challenge connecting and supporting a large, geographically dispersed provider network—comprised of 3,550 physicians and 1,300 Medicare Advantage (MA) providers—with a very diverse patient population. This IPA’s goal was to remain profitable, while improving administrative and care management efficiency in state Medicaid and Medicare programs, and to grow in market share.

 

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Finding Dynamic, Scalable Systems to Process Healthcare Payments

What does your organization need to consider when preparing for capitation payments? Get the details in this report.

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CGT-eBook-4-Reasons-to-Start-Preparing-Now-for-a-Future-of-Capitated-Payments-cover2The Future is Now 

Capitation payment models are on the rise. Read our latest eBook to discover how providers and payers who prepare for this industry shift can position themselves for greater long-term success.

 

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An Expert Team with Deep Experience

Solving for ALL Contracts and Fee Schedules

No matter where you are in the process. 

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Evaluate Market. Design Goals. Analyze Results.

We can help you do it all. 

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eBook

4 Reasons to Start Preparing Now for a Future of Capitated Payments

Value-based care initiatives and goals are not going away. Both CMS and commercial payers are leaning into new models that can keep costs low, maintain high quality standards, and address issues like access to care and patient satisfaction – and HDOs share the same goals.

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Blog Post

Managing Multiple Provider Contracts and Complex Capitation Models

As value-based care models become more prevalent in the healthcare sector, the complexities of capitation models are increasing.

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Blog Post

Times are Changing. Can Your Payment Processing Solution Keep Up?

Just five years ago, the majority of healthcare organizations would tell you that they needed payment technology optimized for fee-for-service (FFS) arrangements. Now, the situation is dramatically different.

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Blog Post

Managing Enrollment and Eligibility Lists for Accurate Monthly Payments in Healthcare

Navigating capitation payment models can be dauting for healthcare providers and payers, especially with the constant flux of member enrollment and eligibility lists to be managed.

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Blog Post

Tracking Risk and Quality Scores at the Member Level: The Key to Maximizing Reimbursement in a Capitated Payment Model

We built a payment technology solution to meet the specific needs of providers and payers engaged in alternative payment models, like partial and full capitation. This helps streamline the process of risk score capture, member attribution, funds flow projection, and payment reconciliation…

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EXPLORE SOLUTIONS

The right solution for your value-based journey is only a click away. Our modular technology is quickly and easily integrated into current systems and complements existing IT investments so that we can grow with you. Learn more today!

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