Succeed in a future of capitated payments with our complete suite of tools for managing delegated risk alongside fee-for-service payments, from contract configuration and eligibility management to adjudication and payment.
Discover what makes our Capitation Adjudication software the only tool you need to seamlessly administer capitation contracts, process payments, manage utilization, and boost financial performance in APMs.
Many organizations engaging in capitated payment models don’t have tools that can accurately and seamlessly track beneficiary alignment. Manually compiling the information is time-consuming, and introduces opportunities for data errors or security breaches. But waiting for annual or semi-annual reconciliations can lead to significant revenue errors – underpayment and overpayment – as beneficiaries change.
Cedar Gate’s capitation software was specifically built for risk-based payment models to:
To succeed in capitated payment arrangements, organizations must have accurate, comprehensive, and timely visibility into claims from network providers and reimbursements from payers – the “funds flow” through a healthcare delivery organization. This level of analysis requires deep understanding of what’s contributing to total cost of care and quality metric scores.
We are the only software platform offering seamless integration between analytics and capitation payment software. Our single data lake ingests multiple data types, cleansing, normalizing, and enriching the information for use across our entire platform. The result is powerful analytics insights on payment allocation trends and distribution patterns to help organizations:
Quickly get new lines of business up and running with streamlined program creation tools from Cedar Gate. Once you identify the setup that works, our software offers “copy and paste” functionality, with the ability to customize the additional lines of business based on contract parameters. Expand in weeks, not months or years, and take advantage of marketing opportunities to maintain a financial and operational advantage.
Cedar Gate’s capitation software allows you to manage providers under a single provider ID, and easily configure specific payments for multiple contracts, automatically track eligibility, and reconcile payments with a comprehensive audit trail to ensure accuracy.
Create an efficient system for Medicaid compliance reporting on authorizations, referral determinations, appeals, and grievances. Our payment technology automatically creates an audit trail that supports reporting requirements for a variety of government capitation payment models, including Medicaid and Medicare Advantage. Simplify the reporting process with preconfigured or customizable templates to save time and money.
When a West Coast IPA wanted to expand their Medicare and Medicaid business lines, they turned to Cedar Gate. Our advanced claims processing, care management, and utilization management tools helped streamline operational efficiency by automating complex administrative processes and identify care opportunities.
The right solution for your value-based journey is only a click away. Our modular technology is quickly and easily integrated into current systems and complements existing IT investments so that we can grow with you.
