Konsulta capitation
The money follows empanelment, not filing
For an accredited primary care facility, capitation is money earned without a single claim being filed — and it is the line nobody can see. It never appears in a claims report, because it is never claimed. Unless somebody counts empanelled members against payment advices by hand, the facility does not know what it earned or whether it arrived. eMRCare keeps that count.
The distinction that matters
Capitation is not a claim
Staff who have spent years filing case rates reasonably assume capitation works the same way, and it does not. There is no claim form per capitated patient and nothing travels the electronic claims path. PhilHealth pays per empanelled member. That single difference moves the revenue-earning act away from the desk that files and onto the desk that registers, empanels and screens.
| Case-rate claiming | Konsulta capitation | |
|---|---|---|
| What earns the money | A service that is filed, accepted and paid. | An empanelled member with a completed First Patient Encounter. |
| What the facility sends | A claim, with its supporting forms and attachments. | Nothing, per member. Capitation is not filed. |
| How payment becomes known | Claim status comes back against each claim. | A payment advice arrives covering a batch of members. |
| How it is lost | A claim is rejected, returned, or never filed at all. | A member is empanelled and never comes back for the encounter. |
| What eMRCare does | Assembles and validates claims, submits them, then reconciles the series. | Keeps a register of what was earned against what was paid. |
How it is released
Two tranches, two different triggers
First tranche
On registration and the First Patient Encounter.
This one the facility controls. The member is registered and empanelled, the encounter screening is completed and recorded, and the amount is earned. Both conditions must hold — an empanelled member with no encounter earns nothing yet.
Second tranche
On year-end performance, as the facility has it recorded.
This one turns on how the year is judged, not on anything already recorded in the clinic. The register projects it across every empanelled member and labels it plainly as an expectation rather than an entitlement, so nobody budgets against a figure that has not been decided.
Per member
Three things must be true before a member earns
Register the resident
The person exists in the facility's patient registry with a record that can be found again — searchable details, a health card carrying a scannable code, and informed consent captured and revocable. Everything downstream hangs off this record, so a duplicate or a half-finished registration is a revenue problem, not just a tidiness one.
Complete the YAKAP empanelment
Empanelment itself runs on PhilHealth's own portal — the identity check, the empanelment slip terms explained to the beneficiary, their agreement, and the signature check that closes it. eMRCare does not perform those steps; it records the outcome of each one as staff complete them, so the facility holds its own evidence of who is empanelled, when, and until when.
Complete the First Patient Encounter screening
The health screening form set out in PhilHealth Circular 2024-0013, Annex G — history, review of systems, examination and the rest — completed in the system and printable for the facility's own file. It is a clinical instrument first, but it is also the second gate on the first tranche.
The register counts a member toward the first tranche only when the empanelment is complete and an encounter is recorded. Both, not either — which is exactly why a facility can run a successful empanelment drive and still earn less than it expected.
The register
What the capitation register shows
One page per program year. Every figure on it is derived from the facility's own records, except the payments, which are entered from the advice.
| Figure | What it means |
|---|---|
| Members empanelled | Counted in the program year they were empanelled in, with empanelments still in progress shown separately beside it. Those are pipeline, not earnings. |
| Members with an encounter | How many of the empanelled have a completed First Patient Encounter. This is the count the first tranche is actually earned on. |
| Expected, first tranche | Earned per member who is both empanelled and screened, at the rate the facility entered. |
| Expected, second tranche | Projected across every empanelled member, and labelled as an expectation because it depends on year-end performance. |
| Received | The total of the payment advices entered, split by which tranche each settles. |
| Outstanding | Earned less received on the first tranche. A negative number means PhilHealth paid more than the clinic's own records account for — worth chasing in either direction. |
| One encounter away | The money the facility would earn if every empanelled member without an encounter had one. The most useful number on the page. |
That last figure is the one worth acting on. Those members are already found, registered and empanelled — the expensive work is done and only a visit is missing. The facility has already paid the cost of earning it.
Working the list
Who has not earned yet, and why
Alongside the totals the register lists the members who have not earned, each with the reason stated in plain words rather than left to be worked out:
No First Patient Encounter recorded
Empanelment is done; the screening is not. One visit closes it. These rows are listed first, and each shows what that single member is worth.
Empanelment not completed
The member is somewhere in the empanelment sequence and has not come out of it. The portal steps have to be finished before the encounter counts for anything.
The order is deliberate. Members needing only an encounter come first because that is the cheapest money to collect, and every row links straight through to the person's record — so the list is a call sheet for the health workers, not a report to be filed.
Reconciliation
Recording what actually arrived
Everything above — who is empanelled, who has been screened, what that should be worth — the system can derive. What it cannot derive is what PhilHealth actually remitted. Only the payment advice knows that, so it is entered by hand: the date received, the amount, which tranche it settles, the members it covers where the advice states them, and the voucher, cheque or transaction reference. The system records who entered it, and a payment entered in error can be removed.
Once both halves are present the register answers the question the facility actually has. Not "how many did we empanel", but "we earned this, we received that, and here is the difference" — with a list of named members explaining the rest.
What this is, and what it is not. The capitation register does not transmit anything to PhilHealth. Empanelment is completed in PhilHealth's own portal and capitation payments arrive as advices; eMRCare reconciles the clinic's own records against those advices once someone enters them. It is a register and a reconciliation tool, not a transmission channel, and it should not be bought as one.
The rates are the facility's to set. Each facility enters its own rate per member and the split between the two tranches, and records on the same screen which PhilHealth circular those figures came from. PhilHealth revises them by circular and they differ between government and private facilities, so eMRCare asserts no figure of its own. If no source has been recorded, the register says so at the top of the page rather than letting unverified numbers read as authoritative.
See it against your own numbers
Capitation sits inside the wider record — the encounter pipeline that produces the screening, the empanelment that gates it, and the separate claims path for everything that is genuinely filed.
Related: what the system does, module by module · claims submission and statutory reporting · how deployment works