Capitation Receipt

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Introduction

Capitation Receipts accept 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 patient and hence does not affect AR. Clinics enter in agreement with Insurance Companies which pay 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. Insurance having an IPA plan or IPA organization.

Pay Mode: This is a mandatory field. This drop down provides two modes of payment to accept Receipt. The payment modes are:

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

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

Credit Card: When the Credit Card option is selected, a new three dotted button is displayed which helps the users to document details for Credit Card on Capitation screen. When Credit Card option is selected, the fields Check No, Check Date are disabled. A three dotted button is displayed next to the payment option is enabled where one would be able to document Details for 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".
Payment Transaction has failed.

Click on 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 on 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 user selects the option Other Pay from the dropdown of the field and clicks on the three dotted button present next to the field Pay mode, Payment Mode Details popup is invoked. The popup has two fields Name and Reference No. Name: The field is provided with a dropdown option from where user can select the mode of other payment. List of options available in the dropdown are Other, PAYPAL, HEALTHCARD, NETBANKING, CARECREDIT, EWALLET and EFT. Options that are displayed in the dropdown are governed by a property other.pay.modes. 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.paymodesis left blank then by default following options are displayed in the dropdown of the field: Other, Paypal, NetBanking, PhonePay and HealthCard.

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

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

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

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

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

View Attachment: Clicking on the view icon user can view the attached attachment.

Post Date: The date when the entry was posted. If batch number property is turned on then the creation date of the batch number is taken automically. It is non-editable; or else the date of receipt is taken. Batch date should not exceed today's date or should 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, user can check the checkbox Ready To Post and on save the receipt is Posted.

Capitation Receipt Comments: User can enter the description that is required to asssociate with the Capitation receipt.

Action Buttons:

save: Click Save to either retain changes or post to database if checkbox 'Ready to Post' is marked.

delete: Click button 'Delete' to delete capitation receipt.

reset: Click button 'reset' to undo the changes.

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

Info: Button Info displays fields 'Location', 'Business Unit', 'Rendering Doc' and 'Attending Doc'.

Note: User can generate customized Tabular Reports from Reports → Tabular. These kind of customized reports gives the opportunity to Provider to analyze Profit/Loss when Provider compares amount received by 'Capitation' and tentative amount would have been received as X% of Medicare Allowed Amount. There are four customized reports a) CAP01. b)CAP02. c)CAP03.d) CAP04.