Support Various Nonclaims-based Payment Calculations
NPE is a highly user-configurable payment processing engine that provides healthcare payers with a robust tool set to manage their capitated programs and respond quickly to evolving customer demands for varying payment methodologies. NPE offers a foundation that enables health plans to create and modify innovative payment programs without the need for technical engagement, and it can be easily adapted for enhancement, scalability and future payment models.
NPE is designed to support various nonclaims-based payment calculations. It uses Member, Provider and Benefit data extracts from various source systems to generate PMPM payments for providers and vendors. NPE allows health plans to run multiple preview cycles and validate their payments before executing the final payment run, and it enables timely and efficient responses to provider and vendor payment inquiries with robust payment research tools. Users have immediate access to data and the ability to configure, search, view, edit and export data using an intuitive Web-based interface.
NPE supports multiple types of payments to providers and vendors, including capitation payments, monthly care coordination fees to compensate providers for care coordination responsibilities, monthly administrative fees to compensate providers for care management services above and beyond care delivery and incentive payments for attaining performance-based targets. NPE can also be leveraged to perform periodic settlements, compute withholds and handle other debit or credit arrangements.
Additionally, NPE provides health plans with a comprehensive set of reports that support the detailed analyses of month-over-month payments and enable health plans to identify payment trends. NPE also allows health plans to view source data feeds and monitor the progress of the various steps of the payment processing cycle through Web-based dashboards.
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