Challenges

Patient/Member Challenges:

• Members do not know these terms.
• Members do not understand how to select a provider based on these terms.
• In regards to Capitation payments, members do not know if they are in a capitation arrangement.
• Members do not know billing codes without descriptions.

Payer Challenges:

• Large number of billing codes can be included in bundled and capitation payment arrangements.
• Bundled descriptions from payers do not use common language and can also contain lists of billing codes. 
• Billing codes included rarely contain the description. 
• Some bundled services have timing or other dependencies. Ex: 90 days
• Unsure whether mandate requires the UI to display bundled/capitation payment arrangements to be compliant.