What is capitation? - Capitation and/or delegation supplement - 2022 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 obtains care. In most instances, a capitated health care provider is a medical group or an Independent Practice Association (IPA). Sometimes, the capitated health care provider is an ancillary health care provider or hospital.

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

Also, capitated health care 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.