As of November 2013 and continuing through mid-2015, IBC is migrating membership to a new operating platform.Until all of our business is on the new platform, we will be working with you in a dual claims-processing environment.
Primary care physicians (PCP) will receive two different forms of payment from IBC: electronic funds transfer (EFT)for migrated members and EFT-enabled providers and paper checks for non-migrated members and nonEFT-enabledproviders. The following information was developed to assist our PCPs in understanding Capitation (CAP) and/orthe Quality Incentive Payment System (QIPS) program payments for migrated and non-migrated members using theNaviNet® web portal. Please note, this process only applies to provider offices set up to receive EFT payments.
Note: Only those practices that are eligible to participate in the QIPS program can receive QIPS payments.
Distribution of your CAP and QIPS payments
The process flows below outline how CAP and QIPS payments are distributed and how to access the paymentinformation through NaviNet.
Calculating your EFT payment
Total CAP Payment Amount (NaviNet) $ 13,066.27Paper Check Amount for non-migrated members - $ 789.25EFT CAP Payment for Migrated Members = $ 12,277.02Total QIPS Payment Amount (NaviNet) + $ 1,148.40
Total EFT Payment = $ 13,425.42 Accessing CAP/QIPS rosters and payments
The following are brief instructions to help you navigate the PCP CAP and PCP QIPS Rosters transactions through NaviNet. Please use the online roster to obtain the most up-to-date information.
CAP Roster ? Contains both migrated and non-migrated members
From the Plan Transactions menu, select ePayment, then PCP CAP Rosters.
Next, you will see a screen that allows you to search by month, provider (office location), or tax ID number. Once the appropriate information is entered, select Search.
The results that appear reflect member-level detail of your CAP payment for all members ? both migrated and non-migrated. The total CAP payment amount is displayed within the Capitation Statement summary.
QIPS Roster ? Contains only migrated members
From the Plan Transactions menu, select ePayment, and then QIPS Rosters.
Next, you will see a screen that allows you to search by month, provider (office location), or tax ID number. Once the appropriate information is entered, select Search.
The results that appear reflect member-level detail of your QIPS payment for migrated members only. The EFT QIPS payment amount is displayed within the QIPS Statement summary. To obtain your total QIPS payment amount, add the NaviNet roster payment amount (EFT) to the paper check amount.
For more information
User guides that describe these transactions in greater detail are available in the NaviNet Transaction Changes section of our Business Transformation site. We encourage you to review the guides and check back for any updates.
If you have any questions regarding NaviNet transaction changes, call the eBusiness Hotline at 215-640-7410.
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