Capitation Receipt

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Introduction

Capitation Receipts accept a contractual amount from Insurance – IPA when the IPA pays at the end of the month / quarter, whether or not that person seeks care, per period of time. This amount is not against any claim or for a patient and hence does not affect AR. Clinics enter into agreements with Insurance Companies which pay a contractual amount quarterly/monthly.

Properties: This button is exclusively visible to users with Read Access to the Properties Master screen. Access to this button is strategically granted to enhance user functionality. Clicking the Properties button triggers a popup, presenting a list of properties from the Properties Master screen in PrognoCIS that cater to Capitation Receipts.

Receipt Date: By default, the current date is displayed in this field. The amount displayed is the payment received from the IPA.

Insurance: Select the insurance from the search icon or type in the insurance name in the Insurance field. The insurance must have an IPA plan or an IPA organization.

Pay Mode: This is a mandatory field. This dropdown provides two modes of payment to accept the receipt. The payment modes are:

Check: By default, this option is displayed. Click the icon to enter details about the check in the 'Pay Mode Details' popup, such as 'Check No.', 'Check Date', and 'Bank'.

Cash: Select this option if the amount is collected upfront for the Patient Receipt.

Credit Card: When the Credit Card option is selected, a new three-dotted button is displayed which helps users to document details for the Credit Card on the Capitation screen. When the Credit Card option is selected, the fields Check No. and Check Date are disabled. A three-dotted button displayed next to the payment option is enabled where one is able to document details for the Credit Card such as Card No., Card Holder, and Card Type, if appropriate.

Payment Fail Transaction Popup Icon: The Payment Fail Transaction Popup

icon appears next to the Credit button if:

You have the onlinePaymentStatusUpdate role or are an Admin (SA).
The system property prognocis.payment.gateway.interface is set to "F".
The payment transaction has failed.

Click this icon to invoke the Fail Transaction Details Popup, which enables you to manage and update the status of failed transactions.
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Online Payment Track Status: The Online Payment Track Status

icon appears next to the Credit button if:

You have the onlinePaymentStatusUpdate role or are an Admin (SA).
The system property prognocis.payment.gateway.interface is set to "F".

Click this icon to invoke the Online Payment Track Status popup, which records the status of every payment processed via the payment gateway, whether successful or failed.

Other Pay - When the user selects the option Other Pay from the dropdown of the field and clicks on the three-dotted button present next to the Pay Mode field, the Payment Mode Details popup is invoked. The popup has two fields: Name and Reference No. Name: This field is provided with a dropdown option from which the user can select the mode of other payment. The list of options available in the dropdown includes Other, PAYPAL, HEALTHCARD, NETBANKING, CARECREDIT, EWALLET, and EFT. The options displayed in the dropdown are governed by the property other.pay.modes. The options that are mentioned in the property are displayed in the dropdown in the same sequence as mentioned in the property. If the property era.patreceipt.paymodes is left blank, then by default the following options are displayed in the dropdown of the field: Other, Paypal, NetBanking, PhonePay, and HealthCard.

Reference No: In this field, the user needs to add the transaction reference number. The field supports alphanumeric values and special characters, and the maximum character limit is 30.

Received Amt: The amount received as a Capitation fee. Enter the Capitation Amount received.

Receipt No.: It is a hyperlinked, autogenerated field consisting of a number with the prefix 'CRREC' followed by a 5-digit number. This is property-dependent, era.captrecno.prefix where the number value cannot exceed 20. When the hyperlinked 'Receipt No.' is clicked, a popup with voucher details is displayed. The 'Capitation Receipt - Last Update Detail' popup provides a detailed history of updates to the voucher. The details are 'Claim', 'Code', 'User', and 'Timestamp'.

Batch No.: If the property billing.use.receipt.batchno for the receipt batch number is turned 'ON' (value set to 'Y') and if a batch is open, then that number is assigned; otherwise, a new batch number is automatically created and assigned automatically. In case there are multiple batches, the Plus button helps to select the appropriate batch number.

Attach: This provides an option to attach scanned PDF files on the Receipts screen. This is a good way to keep track of the PDF/document trail in reference to payments received. The attachment is based on the property era.attach.file.extn. The tooltip for this button changes from the word "Attach" to "Detach" if a file is already attached. The icon only attaches documents with the extensions txt, pdf, tif, 835, rmt, and era. If the user tries to attach a document with any other extension, then a message Only Specified Extensions Allowed: txt, pdf, tif, 835, rmt, era is displayed on the Attach button.

View Attachment: Clicking the View icon, the user can view the attachment.

Post Date: The date when the entry was posted. If the batch number property is turned on, then the creation date of the batch number is taken automatically. It is non-editable; otherwise, the date of receipt is used. The batch date should not exceed today's date and should not be less than the receipt date.

Status: This field displays the status of the receipt. The status of the receipt is Posted or Entered.

Ready to Post: Once all the details are entered, the user can select the Ready to Post checkbox, and upon saving, the receipt is Posted.

Capitation Receipt Comments: The user can enter a description to associate with the Capitation receipt.

Action Buttons:

Save: Click Save to either retain the changes or post them to the database if the 'Ready to Post' checkbox is selected.

Delete: Click the Delete button to delete the Capitation receipt.

Reset: Click the Reset button to undo the changes.

Re-open: Once the Capitation receipt is Posted, the Re-open button is enabled. Clicking the Re-open button, the user can reopen the receipt, the status changes to Entered, and the message "Capitation Receipt Reopened Successfully." is displayed.

Info: The Info button displays the fields 'Location', 'Business Unit', 'Rendering Doc', and 'Attending Doc'.

Note: Users can generate customized Tabular Reports from Reports → Tabular. These kinds of customized reports give providers the opportunity to analyze Profit/Loss when comparing the amount received by 'Capitation' and the tentative amount that would have been received as a percentage of the Medicare Allowed Amount. There are four customized reports: a) CAP01, b) CAP02, c) CAP03, and d) CAP04.