> ## Documentation Index
> Fetch the complete documentation index at: https://help.elationhealth.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Posting a Capitation Payment

> Learn how to post capitation payments in Elation Billing

## Overview

Capitation is a payment model in which a payer pays your practice a fixed, periodic amount (typically per-member-per-month, or PMPM) to cover the care of an assigned panel of members, regardless of how many services those members receive. Because Elation Billing is built around patient-level claims, capitation payments are tracked using a payer-level "placeholder" patient so that the lump-sum check can be received, applied, and reconciled.

Use this workflow when:

* You receive a periodic lump-sum check from a payer for an assigned member panel.
* You need to track non-claim-based payments such as Prop 56 supplemental payments or other PMPM-style programs.

If the payment is tied to specific patient claims (fee-for-service), use [Posting a Payment in Elation Billing](/articles/posting-a-payment-in-elation-billing) instead.

<Note>
  This method can also be used to track payments like Prop 56 (a California Medi-Cal supplemental payment program). Use selections you'll remember and apply them consistently across every capitation payment from the same payer.
</Note>

## Before you begin

* The payer must be set up in Elation.
* You must have a Billing role with permission to create patients, create Superbills, and post payments.
* Decide on a custom CPT code (for example, `CAP`) that you will use for every capitation Superbill. The custom CPT code cannot be saved, so it will need to be manually added to the claim each time.
* Have the remittance advice or check details on hand (check number, date, amount, payer).

## Workflow

### Step 1: Create a placeholder Capitation patient

If this is your first capitation payment from this payer, create a placeholder patient that represents the payer's capitation account.

<Steps>
  <Step>
    Create a new patient (see [Add a new patient](https://help.elationhealth.com/articles/add-a-new-patient)) with:

    * **First Name:** The payer name (for example, `Aetna`)
    * **Last Name:** `Capitation`
    * **DOB** and **Sex:** any value (required fields, but not used for capitation).
  </Step>

  <Step>
    Leave address and insurance fields blank — this patient is for accounting purposes only.
  </Step>

  <Step>
    Reuse this same placeholder patient for every future capitation payment from the same payer.
  </Step>
</Steps>

<Tip>
  To keep capitation patients out of clinical patient lists, mark the patient as inactive after creation, or use a consistent naming prefix (for example, `ZZZ Aetna Capitation`) so they sort to the bottom of search results.
</Tip>

### Step 2: Create a Superbill for the capitation period

<Steps>
  <Step>
    [Create a new Superbill](https://help.elationhealth.com/articles/filing-a-claim#creating-a-superbill-in-elation-billing) on the placeholder patient.
  </Step>

  <Step>
    Set:

    * \*\*Rendering Provider - \*\*your practice's default billing provider, or the provider listed on the capitation contract.
    * **Service Location -** for POS select office (`11`) or whichever POS your practice uses for capitation reporting.
    * **From** and **Thru** dates: the dates of service the capitation check covers (typically the calendar month).
          <Tip>
            **Rendering Provider** and **Service Location** settings can be defaulted in the **Settings** → **Practice Settings** → **Claim Defaults**.
          </Tip>
  </Step>

  <Step>
    Add a single claim line:

    * **Code:** your custom capitation code (for example, `CAP`).
    * **CHG (Charge):** the full dollar amount of the capitation check.
    * **Diagnosis:** any valid diagnosis code your practice uses as a default (for example, `Z00.00`) — for capitation claims that are not submitted, this is for internal tracking only.
  </Step>

  <Step>
    Save the Superbill.

    <Warning>
      Do not Lightning Bill the Superbill since there's no insurance tied to the placeholder patient. Instead you can add the Superbill to a Worklist (e.g., by adding a **Capitation** Tag) if you want to can keep track of it more easily.
    </Warning>
  </Step>
</Steps>

<Note>
  Create a new Superbill for each capitation period (usually monthly). Reusing the same placeholder patient is expected; reusing the same Superbill is not.
</Note>

### Step 3: Post the payment and apply the Superbill

<Steps>
  <Step>
    Post the payment as you would any insurance check — see [Posting a Payment in Elation Billing](https://help.elationhealth.com/articles/posting-a-payment-in-elation-billing).

    * **Payer:** the capitation payer.
    * **Payment Method:** how the payer paid you.
    * **Check/Reference #:** the actual check or EFT reference number; use a consistent convention (for example, `CAP-YYYY-MM`) if no check number is available.
    * **Payment Date:** Date the check was deposited or EFT was sent.
    * **Posting Date:** Typically today's date since you're working on posting the payment now.
    * **Amount:** the full check amount.
  </Step>

  <Step>
    Add the capitation Superbill from **Step 2** to the payment. The Superbill number is located at the top of the claim page, next to the patient name.
  </Step>

  <Step>
    Apply the full payment amount to the `CAP` claim line so the Superbill balance is `$0.00`.
  </Step>

  <Step>
    (Recommended) Change the **Bill To** field to `SETTLED`. This is not required, but is recommended.
  </Step>

  <Step>
    Save the payment.
  </Step>
</Steps>

### Step 4: Document and verify

<Steps>
  <Step>
    Add a Payment Note describing the capitation period covered (for example, `Aetna capitation - October 2026, 412 members`).
  </Step>

  <Step>
    Confirm the Superbill shows a `$0.00` balance and a status of `SETTLED`.
  </Step>

  <Step>
    Confirm the payment appears on the placeholder patient's payment history.
  </Step>
</Steps>

## Settling a patient claim to capitation

If you don't send capitation claims (e.g., \$0 claims) to the payer and there's an outstanding balance on the claim, settle the claim to capitation so it closes out without affecting A/R.

<Steps>
  <Step>
    Open the patient's record.
  </Step>

  <Step>
    Click **Claims** → **Charges**.
  </Step>

  <Step>
    Select the charge(s) that are part of the capitation payment period.

    <Tip>
      To select multiple lines at once, hold **Shift** and click to select a continuous range (for example, A through Z), or hold **Ctrl** (Windows) / **Cmd** (Mac) and click to select non-adjacent lines (for example, A, C, G).
    </Tip>
  </Step>

  <Step>
    Click the **Settle** button.

    <Note>
      The confirmation pop-up will tell you how many lines were selected and will be impacted. If it shows `0`, no claim was selected and the page will appear to stall trying to take action on nothing — close the pop-up and re-select the claim(s) before trying again.
    </Note>
  </Step>

  <Step>
    Select **Capitation** as the **Reason**.
  </Step>

  <Step>
    Click **Settle Now**.
  </Step>

  <Step>
    The claim balance will now be \$0.00.
  </Step>
</Steps>

<Tip>
  Run a monthly reconciliation: Use the **Charges and Financial Transactions Report** to look for claims from eligible members and make sure their balances are settled if payment was received.
</Tip>

## Special cases

* **Recurring monthly capitation:** Reuse the same placeholder patient. Create a new Superbill for each month.
* **Retro adjustments / take-backs:** Follow [Posting Voided, Reversed, or Updated Payments](/articles/posting-voided-reversed-or-updated-payments).
* **Mid-month member adds or terms:** If the payer issues an off-cycle adjustment check, post it as a separate payment on the same placeholder patient with a Note explaining the adjustment.
* **Stop-loss or carve-out payments:** Track these separately using a distinct placeholder patient (for example, `Aetna Stop-Loss`) so they don't co-mingle with PMPM revenue.
* **Multiple practice locations under one contract:** If you need per-location reporting, create one placeholder patient per location (for example, `Aetna Capitation - Downtown`).
* **Prop 56 and other supplemental programs:** Use the same workflow with a distinct placeholder patient (for example, `Medi-Cal Prop 56`) and a distinct custom code so the revenue can be reported separately.

## Reporting and reconciliation

* Capitation revenue posted this way will appear in standard payment reports filtered by the placeholder patient or the custom `CAP` code.
* To separate capitation from fee-for-service revenue, filter or group reports by the custom code (for example, `CAP`) or by the placeholder patient.

## Related Articles

* [Posting a Payment in Elation Billing](/articles/posting-a-payment-in-elation-billing)
* [Posting Voided, Reversed, or Updated Payments](/articles/posting-voided-reversed-or-updated-payments)
* [Using the Claims Manager](/articles/using-the-claims-manager)
* [Add or update a fee schedule](/articles/add-update-a-fee-schedule)
* [Add a new patient](/articles/add-a-new-patient)