(214) 826-4373
toll free (800) 929-2858
info@esihealthcaresolutions.com
CAPSTM operating system delivers accurate transaction processing and quantifiable data focused on provider payment, productivity, performance, and value. CAPS was developed and launched in 1999 as a customizable claims adjudication system to identify, track, and reimburse for uninsured services provided by medical school faculty and other providers at publicly funded institutions.

Payment Adjudication

Sustainable Value-Based Payment Models


Our CAPS technology employs a cohesive approach that encompasses a wide array of customized, client-driven payment, utilization, and performance measurement methodologies. CAPS provides the framework to structure performance-based agreements that not only substantiate the services provided and the cost of uncompensated care, but also align operational and performance goals between hospitals, physician organizations and payers.

The CAPS platform is customized with each client's unique business rules allowing for client-specific claim processing and adjudication that will accurately identify the appropriate payment for professional services. CAPS provides measureable and defensible data that focuses on productivity, performance, value, and defined expectations.

Through detailed utilization reporting, productivity analyses, and benchmarking, clients are able to substantiate physician payments, while enhancing physician attraction, retention, productivity, and engagement, as well as improving quality, outcomes, and patient satisfaction.

Features:

+ Designed to encompass a wide array of client-driven payment methodologies

+ Supports alternative payment models such as P4P, bundled payments, etc.

+ HIPAA and HITECH compliant

+ Robust financial and clinical data reporting

Did You Know?

+ CAPS has a 98% claim accuracy rate, compared to leading commercial payers at 93%

+ CAPS helped one client substantiate and receive additional uncompensated care funding of $125 million annually

+ CAPS has identified tens of millions of dollars in third party coverage for care originally identified as uninsured

 

What Our Clients Say

CAPS has provided the much needed structure to make necessary changes to our payment model for professional services between Parkland and UT Southwestern Medical School. It has provided the desired transparency between the two entities. Since 2005, CAPS has allowed our organization to successfully and accurately adjudicate claims payment to the medical school of over $40 million a year.

John Dragovits
Former Executive Vice President and CFO
Parkland Health & Hospital System
Contact Us

Are you ready to learn more about our solutions? Contact us for more information:

(214) 826-4373
toll free (800) 929-2858
info@esihealthcaresolutions.com