How is Capitation handled?

There are two basic ways a capitation account may work.

First, you track what is capitated:
You must create an insurance company for the capitation account.
Your patient must have this insurance on their account.
You must create a Tie Carrier to HCPCS link to tie the inventory item number to the insurance.
You must use a negative one (-1) for the Allowable amount as demonstrated below.
This allows you to use the usual and customary charge for the item for tracking purposes.
It will automatically non-allow the entire amount.
It will allow you to generate billing if you desire. (or just print the bills for your own records)
Revenue by Payor reports will show charges equal to non-allowed for all activity for this carrier.
This allows you to compare your billing to your re-imbursement to determine if you are making the profit you expect from this plan.


Second, you don't track what is capitated:
You must create an insurance company for the capitation account.
Your patient must have this insurance on their account.
You must create a Tie Carrier to HCPCS link to tie the inventory item number to the insurance.
Instead of a negative one (-1) in the Allowable amount, you leave it zero (0).
You enter the negative one (-1) in the Special pricing for Payor field of the Tie Carrier to HCPCS.
No price is entered on the order. It goes to orders with no charge, therefore, no billing occurs and no tracking of dollars will occur.

Note:
You do not enter payments on the claims on either method!