Providers in capitated managed care plans who receive flat monthly fees:

In capitated managed care plans, providers agree to receive a flat monthly fee to provide a range of services to their patients, regardless of the number of services actually delivered. Despite this prepayment structure, providers are still required to file claims with Medicaid payers for the services rendered to Medicaid patients. This is an essential practice for ensuring that they receive proper reimbursement for care that may fall outside of the capitated agreement or to fulfill regulatory and reporting requirements.

Filing claims is important not only for reimbursement but also for tracking and documentation purposes, ensuring that care provided under Medicaid is appropriately accounted for. By submitting these claims, providers maintain compliance with Medicaid billing regulations and ensure that they are adequately compensated for the services they provide, even in a capitated environment. This reflects the necessity of existing processes and guidelines that govern claims submissions, irrespective of the payment model in use.