Entering Monthly Capitation Checks

The monthly capitation checks that are received from the insurance company are entered under Go To and Capitation Plan Payment on the Patient Lookup List menu bar.

Payments entered here will be tracked on the Managed Care-Plan Report based on the Group Plan that was selected when the check was entered. It is tracked on the Managed Care Report under the Capitation column. There is a separate row, which contains Capitation Payments, shown on the detailed Managed Care Reports.

Since the capitation payments entered on the Capitation Plan Payment screen are not distributed, they will remain in green on this screen. However, they can be posted to History from File on the menu bar.

These payments will appear under the Capitation column on the Managed Care Report.

Monthly capitation checks will not appear on your Accounts Receivable Report, or on the Undistributed Payment Summary Report.

Your Deposit Slip and Daysheet will list the payment with a description of “Capitation Plan Payment”. The description will contain the Group Number and Plan ID Number that was selected.

You can use your usual insurance payment code for your monthly capitation check. The description for the code will automatically change to show the Group Number and Plan ID Number (not the Insurance ID Number) when you enter it on the Capitation Plan Payment screen.

If the capitation check is sent to you electronically, you will need to create a new insurance payment code for electronic fund transfer. This will assure that the electronic check will not appear on your Deposit Slip.

Follow these steps to create a new electronic insurance payment code:

• Enter a new insurance payment code in your Service Code list. You may want the Description to be “Electronic Capitation Payment”.
• Select the Type as Credit, the Category as Pri.Ins. and the SubCategory as EFT. It is important to select the SubCategory as EFT (electronic fund transfer).
• This special EFT code will not appear on your Deposit Slip!

You can now enter this EFT code on the Capitation Plan Payment screen. You will use this code on the special Capitation Plan Payment screen when you receive an electronic monthly capitation check from the insurance company.

You will use your usual insurance payment codes on the patient’s Transaction screen, which will appear under the “I.Collect” column on the Managed Care Report.

Note: If you have other types of payments that are received electronically, you can create additional new payment codes using the Subcategory of EFT. For example, bulk insurance payments might be sent to you electronically. The Subcategory of EFT just prevents the code from appearing on your Deposit Slip.

Follow these steps to enter the monthly capitation check:

• Click on Go To and Capitation Plan Payment on the Patient Lookup List menu bar.
• Enter the insurance payment code (either your usual insurance payment code or the electronic insurance payment code that you created) on the Capitation Plan Payment screen. The Select Managed Care Plan list will open. This is a list of only those insurance companies that were marked with a Plan Type of “Capitation Plan”. The list will include the insurance company name, group number, plan name, plan ID, and insurance company ID.
• Select the capitation insurance plan for this check from the list and click [OK].
• You will return to the Capitation Plan Payment screen. The payment will remain in green on this screen since it is not distributed.
• You can post the payments to History from File on the menu bar.

The payment entered on the Capitation Plan Payment screen is now tracked on your Managed Care Reports.