MODULE

Capitation, Incentive, Fee for Service and Advance Payment 

Choose or combine the best payment model option for your medical group providers between capitation model, quality incentives, fee for service, advances and fix payment.

Risk Contract Management 

Select and manage the line of services you want to contract at risk on a capitation payment model for providers who easily adapt to any risk model.

Claims Editing & Payment Accuracy

Process, audit and pay fee for service claims using an easy module with contractual rules and aging of
unpaid claims.

Encounter processing and Clearinghouse Submission 

Process and audit at "run time" all encounters with contractual rules and sent through in the ANSI 5010 as established by regulation for clearinghouse transactions.

Medical Cost Management 

Evaluate and manage all medical costs in an easy and accurate manner with our premium reporting tool.

HUB/EMR Integration 

We receive the CCD or provide an SDK to migrate data from any electronic medical record certified by CCHIT.

Incorrect Charges of Out of Risk Claims 

Detect incorrect claims expenses allocated to your risk according to any specific model and submit such charges through the contestation process.

Payment Process 

Process payments through the check module which prints and validates automatically the checks and copies.

Analysis & Facility Rate Negotiation 

Facilitate your contractual arrangement process based on the utilization of any given provider.

Smart Cube 

Make your own dashboard reports with a power user using any parameters established in the healthcare industry.

Provider Map and Directory 

Beneficiaries or Affiliates can search through our engine the availability and location of primary care physicians and preferred network providers and trace a path from patient’s location to the provider's office.

© 2017 by SmartCap PR

Alda St. # 1551 Urb. Caribe, San Juan PR 00926-2709  T: 787.625.0450 F: 787.625.0294