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Objective
Pay approved/recoup claims or reimbursements (per visit/service, capitation payment) in a timely manner to designated, plan-approved providers
Input
Financial transactions from accounts payable and receivable GL (approved claim, adjusted claim, void claim)
Capitation list
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Payment voucher (i.e., check, cash, money order, electronic fund transfer)
Feed into data repository
Update provider
Measurable Outcomes
Payment of approved claims claim or capitation reimbursement is paid in the correct amount to the correct provider in a timely manner