Primary Health Care

Capitation Payments: Financial Adjustments

• Background
• Financial Adjustment Process Workflow Diagram
• Financial Adjustment Form

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Background

The adjustment workflow depicts the "Commonly Accepted" workflow to request, calculate, approve and process (pay) financial adjustments. The workflow excludes Fee For Service (FFS) adjustments as they are automated and have no human calculation or approval.

There are 4 main categories of adjustment:

• Error corrections Adjustments to address errors that may have occurred in previous months or quarters for any exception or reason. Requests for these adjustments could come from any sector participant including Practices.

• Policy adjustments Regular adjustments to instantiate or adjust the business rules that CBF should be using for a particular set of capitation rates.

• One-off adjustments Exceptional adjustments often initiated by a DHB including PHO establishment, Care Plus preparatory etc.

• FFS Adjustments Automated adjustments applied directly to Proclaim from GMS claims.

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Financial Adjustment Process Workflow Diagram

Financial Adjustment Process Workflow Diagram (Word, 119 KB)
Financial Adjustment Process Workflow Diagram (PDF, 100 KB)
Financial Adjustment Process Workflow Diagram (VSD, 142 KB)

NOTE: This is the revised PHO Adjustment workflow that is currently being piloted within Ministry of Health

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Financial Adjustment Form

PHO Financial Adjustment Form (Word, 657 KB)

Page last updated: March 2007