Capitation Models

The management of capitated contracts with primary care and specialty provider networks is a unique and critical requirement of the managed care industry. Understanding and performing the calculations is important and communicating that data with timely and understandable reports is also important. Optima MMG  has experience with many varied calculation methodologies, including age/sex adjusted, and has developed reports to effectively communicate capitation data to physicians.

Optima MMG can process capitation payments for concurrent month distribution, for both primary care and specialty providers. Optima MMG can also process capitation on a delayed basis as well. Capitation expense reports are generated monthly and include:

  • Capitation expense by Health Plan and product line
  • Capitation expense by Provider
  • Capitation check detail with membership by PCP (E-list)
  • Capitation calculation detail (member months) for each PCP
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“Optima offers a fantastic service! It is so easy to use and the customer support is the best around class for management services. Highly recommend them.”

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Our Services

Optima Medical Management Group, Inc. (OMMG) provides operational, business development, administrative and technical healthcare management services to large physician organizations and health plans. Check out our wide range of services.

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OMMG’s clients included approximately 1000+ physicians and 350,000 patients in Independent Physician Association (IPA). OMMG processes more than $10 million annually in healthcare claims and other medical reimbursements. OMMG’s clients are located throughout California.

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