How to Automate MedVision QuickCap

A PACE program is the insurer and the provider at once

MedVision has been building healthcare administration software since 1994, and QuickCap, now in version 7, is the platform behind organisations that carry risk: accountable care organisations, independent physician associations, management services organisations, third party administrators, and PACE and LIFE programs.

PACE is an unusual model even inside healthcare. A program enrols frail older adults who already qualify for nursing home care and keeps them living at home instead, and it is paid a fixed amount per participant per month to cover everything: the day centre, the primary care, the specialists, the hospital stay, the medication, the wheelchair and the ride to the appointment.

So the program is the payer and the care team in the same building. When a participant is admitted to hospital, the program is both the organisation paying that bill and the one whose care plan did not prevent it. Very little in healthcare sits on both sides of that line.

The interdisciplinary team meets whether the paperwork is ready or not

An interdisciplinary team meets constantly, because PACE requires it, and the meeting only works if somebody has done the gathering beforehand.

Which participants were in hospital this week and what happened to them. Whose level of care recertification is due. Which authorisations are still outstanding at a contracted specialist. What the transport vendor ran and did not run. Which grievances are open and how close their response deadlines are. What the state wants filed this month.

Some of that is in QuickCap. A great deal of it is on a hospital's portal, a specialty group's system, a pharmacy site, a transport vendor's dashboard or a state Medicaid page, and it reaches the meeting because a care coordinator went and looked. When nobody looks, the first sign is a claim, and by then the participant has been in a hospital bed for four days.

MedVision QuickCap

Admissions found the same night Hospital portals checked on a schedule, so an unplanned admission reaches the team while discharge is still being planned.

Capitation matched to the active roster Every enrolled participant checked against what was actually paid, with unexpected rates and post-disenrolment payments raised.

Deadlines that arrive early Recertification windows, grievance responses and appeal dates gathered into one list, ordered by what closes first.

QuickCap settles the money once the encounter reaches it

On the administrative side the platform is thorough, and it is built for exactly this shape of organisation.

Referral and claims administration runs the authorisation and claim lifecycle. Capitation-based reimbursement structures can be built and calculated, with reporting for monthly or yearly capitation. Case management is offered for running the interdisciplinary team itself, alongside faster team communications, and the utilisation of transportation, primary, specialty and ancillary services provided to PACE or LIFE members can be tracked. Enrolment is supported with health plan verification and customisable assessments intended to reduce eligibility denials. There are clinical alerts, credentialing, HEDIS, a risk adjustment factor dashboard, and complete audit trails for compliance.

That is a strong administrative spine, and it acts on what has arrived in QuickCap.

The hospital admission has not arrived yet. Neither has the authorisation request sitting in a specialist's own system, the pharmacy's fill history, the state's eligibility file for a dually eligible participant, or the pickup the transport vendor recorded as missed.

The hospital knows about the admission before the program does

The team meets with the week already assembled. Half a dozen outside websites were read the evening before, and nobody stayed to read them.

Hospital and emergency department portals checked through the evening, so an admission is on the team's list the next morning instead of on a claim next month, and a care coordinator can be at the bedside while discharge is still being planned.

Level of care recertification dates set against what has actually been completed and submitted. Eligibility checked on the state's site for every dually eligible participant before the capitation month closes, so a retroactive disenrolment is caught rather than clawed back. Capitation payments matched participant by participant against the active roster, with anyone paid at an unexpected rate, or paid after leaving, raised. Authorisations chased on the specialist's own portal. Grievance and appeal deadlines gathered with the date each response is due, soonest first.

The boundary here allows no exceptions, because a PACE participant is frail by definition. It may collect, it may match, and it may flag, all without anyone watching. No clinical decision is made, no authorisation is approved or denied, and anything reaching a participant, a family or a regulator is drafted for a qualified person to review and send.

Nobody on the interdisciplinary team should be checking a hospital portal

A PACE program is staffed by a small number of people who between them know every participant personally. Sending one of them to a hospital website to find out whether somebody was admitted overnight is an expensive way to learn a fact.

WebRun is an agent that operates a real Chrome browser under your own logins. It opens the hospital portal, the state Medicaid page, the specialist's system or the transport vendor's dashboard, reads what is there, and brings back a list with the participant and the date attached.

It runs on your schedule in your own private environment, sessions are not shared between workflows, and a workflow can be locked to a named list of domains. You can watch a run and stop it.

The workflows below are already built, and each one names what it opens.