Jan 1, 2020

  • Applicable to all states except NC

Applicable to all states e...
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What is Capitation? - 2020 Administrative Guide

Capitation is a payment arrangement for health care providers. If you have a capitation agreement with us, we pay you a set amount for each member assigned to you per period of time. We pay you whether or not that person seeks care. In most instances, a capitated provider is a medical group or an Independent Practice Association (IPA). Sometimes, the capitated provider is an ancillary provider or hospital.

For this supplement, we use the term “medical group/IPA” interchangeably with “capitated providers”.

Also, capitated providers may be subject to the protocols, policies and procedures related to any or all delegated activities. Refer to your Delegation Grids within the Agreements to determine which delegated activities, if any, you perform on behalf of UnitedHealthcare.