Cedar Gate's capitation adjudication software is designed to manage the complexities of alternative payment models (APMs) in healthcare. It provides tools for administering capitation contracts, processing payments, managing utilization, and enhancing financial performance. The software supports both delegated risk and fee-for-service payments, offering features like contract configuration, eligibility management, adjudication, and payment processing.

Key Features

• Contract Administration: Efficiently manage complex capitation contracts to optimize financial performance and reduce errors.
  • Automate contract configuration.
  • Enhance operational efficiency.
• Payment Processing: Simplify PMPM (Per Member Per Month) payments for optimal cash flow.
  • Auto-adjudicate claims.
  • Reconcile payments.
• Utilization Management: Create workflows to manage patient risk, quality, and cost.
  • Maintain updated eligibility and provider assignments automatically.
• Data Integration: Integrate data from various sources into a unified data lake.
  • Automatically cleanse, normalize, and enrich data for high-quality insights.
• Reporting and Oversight: Use comprehensive reporting tools to maintain oversight and track risk throughout capitation contracts.

Benefits

• Operational Efficiency: Automate complex administrative processes to streamline operations.
  • Identify care opportunities through advanced care management tools.
• Financial Performance: Optimize financial outcomes by reducing errors and enhancing cash flow.
• Member Experience: Improve member satisfaction by enhancing operational efficiency and reducing administrative burdens.