Primary Health Care

Capitation Payments: Quarterly Register Process

• Background
• Quarterly Register Process Workflow Diagrams
• CBF Quarterly Processing Communications
• CBF Implemented Business Rules
• CBF Quarterly Payment Reports
• Examples of CBF Quarterly Payment Reports
• CBF Patient Management System, User Acceptance Testing Support
• PHO Datamart
• CBF Quarterly Reports Workshop Results
• Quarterly Data Quality Reports for Practices

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  Background

  The quarterly register process workflow reflects the flow of enrolment data from the source at practices, through aggregation and submission by the PHO, data enrichment and funding calculation by the Ministry and then deployment of the enriched individual registers back into the sector..

The aggregated PHO Registers are first verified manually by and then subsequently against the reference data. PHOs are advised prior to full register processing whether there are issues with the submitted register. Once the submission window is closed, the registers are completely validated then enriched at Crichlows and NZHIS for Geocode and NHI respectively..

De-duplication occurs at a national level before final capitation calculation occurs. The resultant capitation figure is subsequently submitted to ProClaim for payment processing. The enriched, de-duplicated register is returned to PHOs, along with the Capitation Summary Report (CSR), where the PHO registers are disaggregated and distributed to the Practices for upload into their practice management systems.

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Quarterly Register Process Workflow Diagrams

Part 1

Part 2

Part 3

Monthly Payment Process

Quarterly Register Process Workflow Diagram (Word, 344 KB)
Quarterly Register Process Workflow Diagram (PDF, 265 KB)
Quarterly Register Process Workflow Diagram Part 1 (VSD, 127 KB)
Quarterly Register Process Workflow Diagram Part 2 (VSD, 123 KB)
Quarterly Register Process Workflow Diagram Part 3 (VSD, 125 KB)
Monthly Payment Process Diagram (VSD, 122 KB)

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CBF Quarterly Processing Communications

CBF Quarterly Processing Communications (Word, 110 KB)
CBF Quarterly Processing Communications (PDF, 47 KB)

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CBF Implemented Business Rules

CBF Implemented Business Rules (Word, 1 MB)
CBF Implemented Business Rules (PDF, 88 KB)

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CBF Quarterly Payment Reports

CBF Quarterly Reports (Word, 76 KB)
CBF Quarterly Reports (PDF, 25 KB)

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Examples of CBF Quarterly Payment Report

• Register Processing Statistics (Excel, 53 KB)
• Capitation Detailed Extract (CSV, 655 KB)
• Capitation Summary Report for DHB (Excel, 384 KB)
• Capitation Summary Report for Organisation (Excel, 135 KB)
• HL7 Error Report (ERR, 1 KB)
• HL7 Acknowledgement Report (ACK, 0 KB)
• Validated HL7 File (ASR, 1 KB)

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CBF Patient Management System (PMS) User Acceptance Testing (UAT) Support

PHO HL7 Register Testing Facility (Word, 260 KB)
PHO HL7 Register Testing Facility (PDF, 36 KB)

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CBF Quarterly Reports Workshop Results - July 2007

Quarterly Reports Workshop Results (Word, 111 KB)

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PHO Datamart

The purpose of the PHO Enrolment Collection is to provide a national collection that holds Primary Healthcare System (PHCS) patient enrolment data for the following uses:

• To assist PHOs, DHBs and the Ministry of Health in reporting and monitoring patient enrolment under the PHCS
• To provide PHOs, DHBs, the Ministry of Health and health researchers with population data to assist with population health research
• To assist PHOs in examining and improving the quality of their enrolment information.

NZHIS PHO Datamart Page

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Quarterly Data Quality Reports for Practices

Data Quality files for Primary Practices Information Pack (Word, 106 KB)
Data Quality files for Primary Practices Information Pack (PDF, 75 KB)


Page last updated: 3 December 2007