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Primary Health Care

Capitation Payments: Client Enrolment Activities


Background


The Client Enrolment Process workflow reflects the typical activities related to capturing and updating client or patient details, including enrolment, at a practice. Because of the number of practices, this workflow is subject to a great degree of variation within the sector for reasons of the practice's administration, protocols, systems and ultimately the relationship they have with their clients.

Most client visits are from existing, PHO enrolled clients. The data the practice holds, either manually or electronically, can be of variable accuracy or completeness. Complete and accurate address data is important for subsequent capitation funding. Because a demographic profile is used as a proxy for the capitation funding rate, a geo-spatial value is derived from the address data on each enrollee record.

The Ministry's primary requirement of the practice is to achieve and provide accurate data for their enrolled and casual (for FFS adjustments) clients. As the calculation of capitation funding is derived from the data captured at source by the practice, it is imperative that processes and systems are in place to maximise the completeness and accuracy of the data associated with the individual.

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Client Enrolment Process Workflow Diagrams



Client Enrolment Process Workflow - Part 1.
Part 1
Client Enrolment Process Workflow - Part 2.
Part 2


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Capitation Enrolment and Register Handling Guidelines


This document provides Practices, Primary Health Organisations (PHOs), Management Service Organisations (MSOs) and the Ministry with a reference for recommended processes to improve the quality of patient health data available to the Sector as part of the Quarterly Register Processing (QRP) cycle.

Enrolment form template




Page last updated: 4 March 2009
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