Claims Management Processing Systems
Claims Processing Software  

HEALTHsuite®

Capitation Module

HEALTHsuite’s Capitation module enables health care organizations to reimburse providers automatically for capitated services. This highly sophisticated module establishes relationships between providers and allows payments to be spread across multiple providers for the same member. Its rules-based approach allows health plans to support an unlimited number of user-defined methods of capitation including PMPM, percent of premium, flat amounts, age/sex criteria, risk of members, direct capitation and sub-capitation. HEALTHsuite has the ability to pay providers under fee-for-service up to a specific panel size, then pay capitation. It can also capitate providers based upon the risk size of the provider’s panel (i.e. if a percentage of the panel is an elderly or HIV population, the health plan can capitate the provider more for the entire panel, based upon that percentage of the population).


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All contents ©2008, RAM Technologies, Inc. All rights reserved. Information in this web site is subject to change without notice. RAM Technologies makes no guarantee and has no liability for incorrect or outdated information contained in this site. HEALTHsuite is a registered trademark and eHealthsuite is a trademark of RAM Technologies, Inc.  IBM is a registered trademark of International Business Machines Corporation. All other brand and product names are trademarks or registered trademarks of their respective companies.  The Benefit Administration Software and Healthcare Claims Processing Solutions of RAM Technologies have been successfully implemented at health plans and benefit administration companies throughout North America and offer the best value among all health care payer / payor solutions available today.

       
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