IT Systems & Services

IT Systems & Services

This training will be focused on IT Systems & Services for the Capitated Preparedness Payment Project (CP3). The attendees will largely be clinics that have volunteered to participate as pilot sites. Based on requests from members we are now opening these June trainings up to the full CPCA membership. If your organization is participating in the pilot but perhaps not your site and you want to learn more about the pilot we encourage you to attend these trainings. If you just want to learn more about how processes and systems would change in an alternative payment model these trainings are for you. We would be thrilled to have you join your colleagues and the CP3 team as we learn from our content experts Bluenovo. 

Objectives. Participants will learn how to create, configure and maintain information systems and/or manage IT service providers that:

  1. Manage electronic claims and encounter file submissions
  2. Manage and process electronic eligibility files
  3. Process and manage capitation payments
  4. Capture charges and services, conduct appropriate coding in an EHR and link to care management, population health and registry services
  5. Support practice management (e.g., schedule appointments, capturing charges, submitting claims)
  6. Receive clinical and administrative information from third parties, including from claims, admission/discharge/transfer (ADT) and clinical information systems
  7. Integrate internal and external clinical and administrative data for reporting and analysis
  8. Accurately code and track relevant quality measures
  9. Connecting clinic EHRs with tools that support care and case management and decision support services

 Curriculum Description

  1. Eligibility, claims, payment processing and electronic data interchange (EDI):
    1. Utilizing systems to support:
      1. Submission of claims and encounter files (e.g., using clearinghouses, point-to-point)
      2. Receiving and managing eligibility files
      3. Identifying and managing members with no visits, encounters or touch points
      4. Member matching, including identifying members in pilots and distinguishing between assigned members and other patients
    2. Configuring systems to properly code and account for alternative touches
  2. EHR:
    1. Clinical and administrative documentation requirements under capitated arrangements
    2. Capturing alternative touches
    3. Developing policies describing who can access, document and code in the EHR
  3. Practice management:
    1. Determining necessary and appropriate level and location of care
    2. Managing scheduling for members assigned to sites of care
    3. Documenting alternative touches
  4. Claims/administrative data integration:
    1. Configuring systems to consistently and accurately report correct information to plans
  5. Health information exchange:
    1. Receiving and integrating files from external partners (e.g., plans, other providers)
  6. Data integration, analysis, and reporting:
    1. Managing and integrating internal and external data sources
  7. Quality Improvement
    1. Configuring EMR to code and capture quality measures (e.g., HEDIS)
  8. Care/case management and decision support:
    1. Developing decision support tools, prompts and alerts

Suggested team member participants:  C Suite (CIO, COO), IT Staff, Social Services, Population Health Management, Reporting and Analytics Staff, Patient Engagement

If you have any dietary restrictions, please email Charlotte Reische, at

6/23/2017 9:00 AM - 4:30 PM
Delhi Center 505 East Central Ave Santa Ana, CA 92707 UNITED STATES
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