Designed to accommodate capitated reimbursement models and fee-for-service discounted payment options, the HMO module that integrates with TriZetto's QicLinkTM Extended Enterprise system calculates capitation payments to primary care and specialty physicians. It also handles other popular calculation options including:
- Age of patient
- Age/sex
- Schedule of benefits
- Flat rate
- Other user-defined options
TriZetto's HMO module provides a comprehensive array of capabilities to simplify complex HMO plan administration. Encounter information is captured for per member per month utilization by specialty, primary care physician (PCP), procedure performed and procedure category and sorts by HMO, group and reporting ID.
This module also supports multiple direct capitation relationships, such as member to provider, as well as indirect capitation relationships, including PCP to member or all members to a lab. Extensive membership/financial reporting is included.
|
Information
|
|
For more detailed information, please call 1-800-569-1222. |
|
| Home
| Contact Us
| Site Map
| Search |
