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