Capitation Payment Type

You should post capitation payments using the remittance record functionality in the Capitation Payment Posting Ledger. If a capitation crosswalk is in place, athenahealth posts per the crosswalk; otherwise, athenahealth posts per details provided on posting remittance. Note these items in your General Ledger and close this remittance record.

Capitation payments are fixed-rate payments, most commonly used by HMOs, established to cover a specified set of services for a specified eligible population. A capitation rate is generally expressed in terms of dollars per member per month. Capitation rates are payment for services rendered, including the cost associated with referrals to hospitals or specialists, as well as the ordering of tests.

1. Display the Capitation Payments page: On the Main Menu, click Financials. Under PAYMENTS, click Capitation Payments.
2. Locate the capitation payment in the list of payments that appears at the bottom of this page.
1. If the list is too long, you can use the filter fields at the top of the page to limit the list to payments that match your criteria.
2. Click Filter. The list of capitation payments that meet your criteria appears. The list is sorted in ascending order by ID number.
   
3. Click the [ capitation payment ID # ] link. The edit view of this page appears.
4. Edit the fields as needed.
5. Click Save. The updated capitation payment appears in the list.

Note: athenahealth will resolve Capitation Payment remittance records and close them as Recorded Capitation Payment. These records can be reviewed on the Capitation Payments page.

1. Display the Find Unpostables page: On the Main Menu, click Financials. Under PAYMENTS, click Unpostables. In the left menu, under UNPOSTABLE REMITTANCE, click Find Unpostables.
   The Find Unpostables page appears.
   
2. Unpostable status — Select OPEN.
3. Unpostable type — Select Capitation Payment.
4. Click Generate Worklist.
   The Unpostables Worklist appears in the Task Bar.

Display the unpostable record

5. From the worklist in the Task Bar, click the Capitation Payment bar to expand the worklist.
6. Click the linked unpostable ID number for the capitation remittance record/unpostable in the worklist.
   The Remittance Record page appears in the Workspace.

In the Status section

7. Under Select an action to resolve or reassign record, select the Update status and reassign record option.
8. Update status — Select Recorded Capitation Payment.
9. Click Submit.

Generate an Unpostables Worklist for capitation checks

1. Display the Find Unpostables page: On the Main Menu, click Financials. Under PAYMENTS, click Unpostables. In the left menu, under UNPOSTABLE REMITTANCE, click Find Unpostables.
   The Find Unpostables page appears.
2. Unpostable status — Select OPEN.
3. Unpostable type — Select Capitation Payment.
4. Click Generate Worklist.
   The Unpostables Worklist appears in the Task Bar.

Display the unpostable record

5. From the worklist in the Task Bar, click the Capitation Payment bar to expand the worklist.
6. Click the linked unpostable ID number for the first capitation remittance record/unpostable in the worklist.
   The Remittance Record page appears in the Workspace.

Enter the capitation check information

7. Scroll down to the Capitation information field (under the Details heading) and click the Record Cap Check link.
   The Capitation Payments page appears in the Workspace, with the payment batch information at the top of the page.
8. Capitation contract — Select the capitation contract associated with the capitation payment.
9. Custom insurance group — Select the payer that issued the capitation check.
10. Check # — Enter the check number.
11. Notes — Enter any notes about this capitation check.
12. Payment Amount — Enter the amount of the capitation payment. A second payment row appears automatically. Typically, you need to fill out only the first row using the entire amount of the check, so you can ignore the new row.
    Note: In rare situations, you may need to split the capitation check into separate payments — for example, by individual providers. You can use the new row to accommodate this scenario. Each time you enter a payment amount, a new row appears. The sum of payments you enter must equal the amount of the check.
13. From Date and To Date fields — Enter the date of service range (required) covered by the capitation check. This selection must match the terms of your contract, so that you can accurately evaluate the contract.
14. Department — Select the service department covered by the capitation payment, if applicable. This selection must match the terms of your contract, so that you can accurately evaluate the contract.
15. Provider — Select the provider covered by the capitation check, if applicable. This selection must match the terms of your contract, so that you can accurately evaluate the contract.
16. When you are finished, click Save.
    Note: You are not required to balance the sum of the Out-of-Balance field.