Capitation Payment Management System (CAPMAN) 820/834
DHCS’s Office of HIPAA Compliance (OHC) is responsible for the management of the Capitation Payment Management System (CAPMAN), which supports federal regulations that require the State of California to maintain member benefit enrollment and accounting for all capitated payments made to managed care health plans using HIPAA compliant transactions.
CAPMAN calculates monthly capitation payment amounts, generates HIPAA compliant 820 premium payment transactions, generates 834 enrollment/disenrollment transactions, and makes the 820 and 834 transactions available to managed care health plans. The 820 transaction is a federally mandated ASC X12 standard to provide premium payment information that allows the managed care health plans to reconcile payments received against members they have enrolled. The 834 transaction is a federally mandated ASC X12 standard to provide member enrollment information, such as new enrollments, changes in a member’s enrollment, reinstatement of a member’s enrollment, and disenrollment of members.
By using standardized transactions, CAPMAN increases interoperability between DHCS and managed care health plans.
Companion Guide - 820 Transaction - Premium Payment
Companion Guide - 834 Transaction - Benefit Enrollment