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.
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.
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.
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.
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.