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Technical Guidance on Capitation for In-Network File #284

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Stephanie-Raymond opened this issue Nov 16, 2021 · 2 comments
Open

Technical Guidance on Capitation for In-Network File #284

Stephanie-Raymond opened this issue Nov 16, 2021 · 2 comments

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@Stephanie-Raymond
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Can CMS/GitHub provide additional guidance and clarifications about technical specifications on how a Plan should handle capitation for purposes of the In-Network Machine Readable File?

Specifically, is the required reportable information the financial arrangement of per member/per month/quarter between the provider and insurer?

Is the plan instructed to provide this capitation rate in lieu of fee for service for associated procedure codes? Or, can capitated services be reported as “encounter” services (the amount the encounter for service would be paid if FFS).
@RLTx1391
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RLTx1391 commented Jun 2, 2022

Has there been any additional guidance here?

@Ginger228
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@shaselton @shaselton-usds
Hi- Any additional update on capitation?

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3 participants
@Ginger228 @RLTx1391 @Stephanie-Raymond