Commercial

Deliver high client value and superior customer service while managing risk through Citra’s comprehensive core benefits and claims administration platform with integrated EDI, care management and analytics. 

Exceed client expectations with EZ-Suite.

• Maximize electronic data interchange, accelerated time to value and flexibility for expansion
• Control complex processes involving benefit plans, provider contracts, and member populations
• Manage Commercial populations and the required reporting and compliance requirements for individual small and large groups
• Leverage actionable analytics to identify and provide care to high-risk/high-utilization members
• Supports comprehensive data needs through collection of provider and member profiles, health plan benefit data, primary care encounters, specialists, authorizations, physician and hospital FFS claims, risk sharing arrangements, and industry standard codes required for end-to-end UM, QM, and claims processing
• Flexibility as models change for calculation of member months via a variety of methodologies: % of Premium, Risk-Adjusted, Tiered Membership or the more traditional health plan benefit option, primary care physician, member condition, age and gender
• Automates timely and accurate payment to capitated providers based on PMPM expenses
• Drive high-quality member and provider engagement
• Support role-based user and security at the module, screen and field level
• Enable full security settings for login attempts, forced password changes, and minimum password requirements
• Complete before and after editing; Audit Trail at the field level

Integrated core benefits and claims administration for today's dynamic commercial market