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Capitation Reconciliation & Financial Management

Cedar Gate’s Cap Check™ is an essential tool for medical groups with capitated contracts to verify that they are receiving correct payments. By reconciling actual payments with expected payments on a member/month basis, you can verify whether you are being paid correctly, and make corrections when you are not.

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Immediate Return on Investment

Are you being paid properly–or leaving money on the table? Cap Check is an essential tool for medical groups with capitated contracts to verify that they are receiving correct payments. By reconciling actual payments with expected payments on a member/month basis, you can verify whether you are being paid correctly, and make corrections when you are not.

Clients have reported immediate returns on investment due to substantial recouped payments as a result of using Cap Check.

Capabilities

  • Easily load member/month payment and expected payment data
  • Automatically calculate expected payments based on current and historical eligibility data and rate tables
  • Automatically prorate payments for partial months
  • Automatically reconcile retroactive payments or eligibility changes
  • Generate easy-to-read reports presenting payment exceptions in detail and summary formats
  • View or export all payment data from an audit screen
  • Define field mappings for importing eligibility and cap data
  • Select standard and custom conversions for dealing with date and currency formats and other needs
  • Enable custom processes to handle special processing needs

Serving

payers

Payers

Manage risk more effectively and obtain greater value for every healthcare dollar.

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providers

Providers

Act on emerging opportunities to transform operations and improve financial performance.

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Employers / ASOs

Recognize high-value innovation opportunities in healthcare with our help.

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Cap Check™ – Financial Management

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SOLUTIONS

Cedar Gate’s enterprise performance management analytics and administration platforms reduce risk, enhance financial performance, and improve patient outcomes for healthcare organizations across the value-based care continuum.

Enterprise Data Management

Capture, organize, and utilize all valuable data sets securely and easily.

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Identify and develop bundle opportunities that reduce spend and improve quality of care.

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Transform the way you report on your business with these intelligent tool sets.

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Support medical management activities across the care continuum.

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Manage patients effectively from chronic conditions to transitions of care.

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Administer retrospective and prospective bundled payment arrangements with clinical excellence.

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Operate multiple lines of business with claims and benefits administration, eligibility, capitation reconciliation, financial management and more.

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Extend your effectiveness with managed, professional, or advisory services.

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