What Is a DOFR? A Plain-English Guide
The Division of Financial Responsibility decides who pays for what in delegated care. Here is what it is, why it exists, and where it quietly breaks.
A Division of Financial Responsibility, or DOFR, is the contract exhibit that spells out which party is financially responsible for each category of care under a delegated or capitated arrangement.
Why the DOFR exists
When a health plan delegates risk to a provider group, both sides need a shared answer to one question: who pays for this claim? The DOFR is that answer, encoded as a grid of service categories mapped to the responsible party.
Where it breaks
- Ambiguous service categories that two teams read differently.
- Amendments that never make it into the claims system.
- Carve-outs that apply only under specific conditions.
If your DOFR lives in a PDF, your claims system does not actually know it.