Capitation Plans Support enhancement

[rsavain]

In 2 or 4 capitation plans that we support, there is a formula that seems to become a standard. The other 2 do not pay supplemental payments.
For those 2 plans we have 1,200 patient enrolled.

In cases that supplemental payments are given they are based on an agreed contracted amounts between the dentist and the insurance company.

One way of having the system help in this process is the expansion of the use of carrier allowed amount. This Fee schedule would only have the Guaranteed amount that the insurance will give for a procedure less the Patient Co-pay Fee schedule.

A flag to activate this option would be needed.

[jordansparks]

The math for this section of the program is the most complex and most fragile of any part of the program. I would need to very carefully go through the code to make sure we are not already internally making use of allowed amounts somehow. I know that we use allowed amounts in the PPO fee schedule, and this would preclude using the allowed fee schedule for anything.

[rsavain]

Jordan,

You do use the Allowed fee schedule in the Catagory Percentage accourding to your documentation. Not the PPO.

But if you set a flag to use the Allowed fee schedule in the manner described for Capitation, the calculations would be different with a fee schedule specified only.

Also, if the fee for a procedure is blank in the Allowed fee schedule, it is not to be added to the claim. The agreement with the Insurance Co. is only for a limited group of procedures.

I hope this is useful.