Capitation Payments

The management of capitated contracts with primary care and specialty provider networks is a unique and critical requirement of the managed care industry. Understanding and performing the necessary calculations is important and communicating that data with timely and understandable reports is also important. AMM has experience with many varied calculation methodologies, including age/sex adjusted, and has developed reports to effectively communicate capitation data to physicians.

AMM can process capitation payments for concurrent month distribution usually by the 25th day of the month for both primary care and specialty providers. AMM can also process capitation on a delayed basis as well. Capitation expense reports are generated monthly and include:

  • Capitation expense by Health Plan and product line

  • Capitation expense by Provider

  • Capitation check detail with membership by PCP (E-list)

  • Capitation calculation detail (member months) for each PCP