Dually Eligible Members

Systematic tight coordination for Dual Eligible Beneficiaries can mitigate disjointed care, misaligned incentives and costly administrative inefficiencies.  Citra’s EZ-Suite allows you to identify the member’s unique coverage needs within one unified view.  With advanced secondary payer pricing models and sophisticated Coordination of Benefits workflows, EZ-Suite relieves the burdens.

While dual-eligible patients tend to make up a small percentage of Medicaid enrollees, they are responsible for considerably higher percentage of the program's expenditures and can be closely managed through the integration and configurable options within the EZ-Suite platform. 

• Members are linked to health plans and options, which define healthcare benefit packaging and financial out-of-pocket liability
• Together these are associated with member: co-pay, coinsurance, out-of-pocket, year-to-date and lifetime limits 
  • The combination of these components determines services for which the member is eligible
• Defined program benefit rules at the health plan package level support integrated workflow, including UM, CM, claims determinations and other processes