Integrating benefits for dually eligible Medicare and Medicaid beneficiaries is a challenge, which requires keen attention to details and sophisticated information technology infrastructure to avoid manual work-arounds. Often, the members who qualify for both Medicare and Medicaid— known as dual-eligible beneficiaries are often the ones who have complex and costly health care needs. Ultimately, the goal is to manage members' overall health care use and outcomes across medical, behavioral health, and long-term care.
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.
EZ-CARE is a dedicated care management module supporting our clients clinical teams’ focus on managing risk, quality of care, reducing costs, and improving patient/member experience. This complete, easy-to-use case management application is designed for the unique workflows of the nurses, doctors, case managers and healthcare administrators engaged in care management roles.
EZ-INFO provides a complete, end-to-end population health platform for delegated IPAs, MSOs and Health Plans managing patients at risk. This solution combines everything from clinical and claims data to biometric and social information in a single location for actionable data, such as managing HCCs, HEDIS, STARS, etc., making program management simple, allowing you to effortlessly maximize revenue and reduce the future cost of care.
Cap Check is an essential tool for medical groups with capitated contracts to verify that they are receiving correct payments. By reconciling actual payments with expected payments on a member/month basis, you can verify whether you are being paid correctly, and make corrections when you are not.