Capitation Payments
Per-member-per-month (PMPM) payment schedules, IPA rules, and processing queue
$2,847,441
Total Capitation This Month
24,812
Member Months
$114.76
Average PMPM
3
Pending Processing
Capitation Schedule
Provider PMPM rates by product line
| Provider / IPA | Product | PMPM Rate | Members | Monthly Amount | Last Paid | Status |
|---|---|---|---|---|---|---|
North Shore Medical Group NPI: 1881923445 |
HMO Gold | $128.50 | 4,112 | $528,392.00 | 2025-02-28 | Active |
Midwest IPA Partners IPA Group — 47 providers |
PPO Silver | $98.25 | 7,844 | $770,673.00 | 2025-02-28 | Active |
Chicago South Community Health FQHC — NPI: 1234567890 |
Medicaid Managed | $87.00 | 3,291 | $286,317.00 | 2025-02-28 | Active |
Lakeview Family Practice Solo Practice — NPI: 1487229341 |
HMO Gold | $128.50 | 892 | $114,622.00 | 2025-02-28 | Active |
West Suburbs Primary Care IPA IPA Group — 23 providers |
Medicare Adv. | $145.75 | 2,187 | $318,754.25 | 2025-02-28 | Pending Review |
IPA Rules
Independent Practice Association rules
Withhold Percentage
10%
Risk withhold on each capitation payment
Stop-Loss Threshold
$50,000
Per-member annual stop-loss reinsurance trigger
Carve-Out Services
Mental Health, Pharmacy, Dental — excluded from cap rate
Processing Queue
March 2025 capitation run
| Provider | Amount | Status |
|---|---|---|
North Shore Medical Group ACH — Routing: 071000013 |
$528,392.00 | Processing |
Midwest IPA Partners ACH — Routing: 071001234 |
$770,673.00 | Processing |
West Suburbs Primary Care IPA Pending contract review |
$318,754.25 | On Hold |
Total pending: $1,617,819.25