Find Member Level Incoming Payment Discrepancies

Based on contracts you have with insurance payers or states, Cap Check calculates what you should receive and verifies that you receive that individual member’s expected payment.  Identifying discrepancies allows you to verify either the accuracy of enrollment information or the recovery request for payments due.

Schedule a Demo

Leaving Money on the Table?

Immediate Return on Investment

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.

Cap Check Key Features:

  • Easily load member/month payment and expected payment data.
  • Expected payments are calculated automatically based on current and historical eligibility data and rate tables.
  • Payments are prorated automatically for partial months.
  • Retroactive payments or eligibility changes are reconciled automatically.
  • Easy-to-read reports present payment exceptions in detail and summary formats.
  • Audit screen allows for flexible viewing or exporting of all payment data.
iStock-667329466

Customization

Users define the field mappings for importing eligibility and cap data. You can also select standard and custom conversions for dealing with date and currency formats, and other needs.

Cap Check has structures that allow for custom processes to handle special processing needs. 


aco-icon-NEW

Accountable Care Organizations

Learn More

 

self-insured-employer-icon-NEW

Self-Insured Employers

Learn More

 

health-plan-icon-correct-NEW

Health
Plans

Learn More

 

IPA-icon-NEW

Independent Practice Associations

Learn More

 

integrated-delivery-system-icon-NEW2

Integrated Delivery Systems

Learn More

 

MSO-icon

Management Services Organizations

Learn More

 

Provider-icon_NEW2

Providers

Learn More

 

TPA-icon-NEW

Third Party Administrators

Learn More

 

LOB-ICONS-Commercial

Commercial

Learn More

 

LOB-ICONS-Duals-NEW

Duals

Learn More

 

LOB-ICONS-Medi-Cal

Medi-Cal

Learn More

 

LOB-ICONS-Medicaid

Medicaid

Learn More

 

LOB-ICONS-Medicare

Medicare Advantage

Learn More

 

LOB-ICONS-Pace-NEW

PACE

Learn More

 

LOB-ICONS-Speciality-NEW

Specialty/Carve-Out

Learn More

 

ez-cap

Core Administration

EZ-CAP is a comprehensive claims and benefit administration system, managing all functions of a managed care organization in a single integrated platform.

Learn More

 

 

ez-care

Utilization/Case/Care Management

EZ-CARE is a dedicated care management module supporting our clients clinical teams’ focus on managing risk, quality of care, reducing costs, and improving patient/member experience. This complete, easy-to-use case management application is designed for the unique workflows of the nurses, doctors, case managers and healthcare administrators engaged in care management roles.

Learn More

 

 

ez-info-2

Analytics

EZ-INFO provides a complete, end-to-end population health platform for delegated IPAs, MSOs and Health Plans managing patients at risk. This solution combines everything from clinical and claims data to biometric and social information in a single location for actionable data, such as managing HCCs, HEDIS, STARS, etc., making program management simple, allowing you to effortlessly maximize revenue and reduce the future cost of care.

Learn More

 

 

ez-edi-new

Electronic Data Interchange

EZ-EDI offers the latest advancement in electronic data interchange (EDI) to easily retrieve information and perform transactions in real-time directly into EZ-CAP, without going through a clearing house.

Learn More

 

 

ez-net-new

Provider Portal

This internet portal facilitates timely, cost-effective sharing of clinical and administrative information between a healthcare organization, network providers, and health plans.

Learn More

 

 

ez-partner-new

Universal API

This application enables software vendors to interface existing systems with EZ-CAP. This Application Programming Interface (API) is an expert modification tool for developers to format request and response file transactions.

Learn More

 

 

citra-cloud-1

Cloud Services

Citra Cloud provides an advanced EZ-CAP cloud-based hosting service that gives you everything you need to run EZ-CAP, EZ-EDI, and EZ-NET. Achieve “plug-and-play” access to your application to safeguard your data and control costs.

Learn More

 

 

eligibility manager

Eligibility Management

Eligibility Manager is a uniquely configurable software solution that makes it easy for IPAs, MSOs, or any population health, delegated group or managed care organization to efficiently manage changes to healthcare member eligibility.

Learn More

 

 

datatug

Eligibility Management

DataTug is a unique product that knows how to find the information you need quickly and accurately for any health plan. DataTug extracts required data automatically from health plan web sites and ANSI X12 270/271 and other data portals.

Learn More

 

 

We are Citra

"If you are listening with intent to your clients, you will be a fantastic vendor and a very successful company."

Scott Sanner, CEO 

Discover what Citra has to offer. Schedule your demo.

Schedule a Demo