Capitation Denial

When a claim is processed towards capitation, what all information do you need to collect from the insurance representative?

• Allowed amount & Capitated amount

• Verify if any patient responsibility is applicable

• What is the contract period for capitation

• All the above

Remark code for Capitation ?

• CO25

• CO96

• CO24

• CO97

Capitation  is the fixed amount paid from an insurer to a provide

• TRUE

• FALSE

The advance payment of a flat fee service is considered as  ?

• Non covered charges

• Capitation

• Authorization

Allowed amount is the main important point to be collected over the call when the call processed towards capitation ?

• TRUE

• FALSE

PECA stands for Process for Executing Client Approval 

• TRUE

• FALSE

If the claim is processed towards Capitation and the process update states need to adjust the claim, which tab do we adjust ?

• Claims tab

• Balance tab

• Insurance tab

if the claim needs to be submitted with corrected claim, what all information to be collected ?

• Appeal address, TFL, payer preferred appeal forms if any, fax #, specific documents, attention

• Corrected claim submission address, TFL, provider preferred claim form if any, fax #, specific documents, attention

• Reprocess the claim

• None

Patient responsibility of PR1, PR2 & PR3 list below

• Deductible, coinsurance & non covered charges

• Co insurance, copay, deductible

• Deductible, co insurance, copay

• Deductible, copay, co insurane