Managed Care (DHMO) carriers require submission of monthly reports that indicate which patients have been seen by the office within a stated date range. In other terms, the carrier wishes to know which patients have utilized the services allowed by their plan. For some procedures, an office can obtain supplemental reimbursement from the carrier for those patients. For these reasons, the office should generate a Capitation Utilization report to the carrier(s).
Click the word “Reports” and choose the “Insurance Reports” option from the drop-down box.
Select the Capitation Utilization report from the list on the left side of the screen, and complete the search parameters on the right side of the screen.
If a checkmark is in the “Print All Codes” box, the report will generate patient utilization of all codes and z-codes (extra service codes). If only codes are to be reported to the carrier, ensure the checkmark does not appear.
To indicate any fee associated with the procedures reported, ensure a checkmark is in the box “Include Fees Charged.”
If the office’s UCR (or other office fee schedule associated to the patients) should be reported to the carrier, a checkmark should be placed in the box “Include UCR.” Once marked, a pull-down menu of applicable fee schedules is shown. Select the desired fee schedule that will be shown on the report for comparison basis.
To print the office location on the report, place a checkmark in the “Print Office Address” box.
Click the Print / Preview button to view the report. From this screen the user can print the report; or save the document as a pdf, Excel, or webpage file.