JLN Process - Payment to providers

Process Group

Accounting

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

Output

• Payment voucher (i.e., check, cash, money order, electronic fund transfer)

• Feed into data repository

• Update provider accumulators

Measurable Outcomes

• Payment of approved claims or capitaton reimbursement is paid in the correct amount to the provider in a timely manner

Sources

• Joint Learning Network, 2012

• File: NHIIS_Phase_1_Public_Report_JLN_IT_Workshop_FINAL_Jan182012_A4.pdf