Project Description

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In the state of California there are 12 million Medi-Cal beneficiaries enrolled in roughly 180 managed care plans. With annual payments currently approaching $40 billion and increasing, TrinityTG’s Managed Care Capitated Payment system (CapMan) provides an automated solution to manage and process payments, beneficiary management, and eligibility data in accordance with The Health Insurance Portability and Accountability Act (HIPAA).

HIPAA requires that managed care plans receive detailed remittance advice from paying agencies reporting all beneficiaries and the associated payment amounts covered by the monthly capitation payments.  CapMan also enhances user experience and efficiency. Read entire case study here: Medi-Cal Managed Care Capitated Payment Calculation System.