Capitation Adjudication

As the complexity of capitated payments goes up, so does the risk of errors that can impact your bottom line. Administer full and partial capitation agreements, fee schedules, and provider contracts accurately to build trust among your network of care providers and delivery organizations.

Track every detail of your capitated arrangements, from the contract level down to individual members. Contract attribution is refreshed automatically at regular intervals, so you always have the most updated monthly eligibility numbers. Identify higher-risk cohorts for targeted interventions that reduce total cost of care.

When you can automate both common and complex tasks, you can succeed in capitated APMs, manage workflows efficiently for team members, minimize errors and mistakes and ensure timely and accurate claims processing. Ultimately that means the right people get the right payments as quickly as possible.

Automated checks and balances ensure accuracy in capitation payment contracts, seamlessly integrating with your existing partner ecosystem and incorporating ANSII and proprietary files to quickly process fee-for-service claims and capitation payments. Keep everyone informed with automated prebuilt or custom reports.