CLAIMS MANAGEMENT

Our Claims Management Systems Includes A Means To Adjudicate Capitated Payments Across The Lab Network

Halfpenny Technologies has developed a proprietary capshare model which allows for processing the capshare distribution for network laboratories. The Halfpenny model applies relative value unit (RVU) methodology to laboratory utilization to determine the network laboratories’ utilization allocation. This model has flexible functionality and can be used for various capshare pool methods including:

• The healthcare primary care physician (PCP) picking the laboratory – The capshare pool is determined by the health plan members who are assigned to the PCP – and capshare distribution is made based upon network lab utilization.

• Overall laboratory utilization (network and non-network laboratory utilization) –The network capshare pool is determined by network laboratory’s utilization in relation to the entire health plan laboratory utilization. The pool is a function of the allocation of utilization.