Capitated Network Management Services

The primary source for revenue for HN1 is through Capitated Network Management Services. Under these payor agreements, HN1 is paid a capitation fee for the professional or both the professional and technical components of one or more medical specialty(ies). As part of these agreements, HN1 may use its existing network of contracted providers, the health plan's existing provider network, or some combination of its provider network and the health plan's provider network. HN1 also would usually assume responsibility for some or all of these operational functions:

  • Claims Payment
  • Referrals/Authorizations
  • Provider Contracting, Provider Relations and Network Development
  • Payor Relations

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