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Dually Eligible Members

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 Medicaidknown 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. 

Seamless Integration

Supporting Dual-Eligible Beneficiaries 

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. 

Citra empowers Empowers Management of Dual Eligible Beneficiaries to:

  • 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 



Accountable Care Organizations

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Self-Insured Employers

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Independent Practice Associations

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Integrated Delivery Systems

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Management Services Organizations

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Third Party Administrators

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Medicare Advantage

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Core Administration

EZ-CAP is a comprehensive claims and benefit administration system, managing all functions of a managed care organization in a single integrated platform.

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Utilization/Case/Care Management

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.

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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.

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Electronic Data Interchange

EZ-EDI offers the latest advancement in electronic data interchange (EDI) to easily retrieve information and perform transactions in real-time directly into EZ-CAP, without going through a clearing house.

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Provider Portal

This internet portal facilitates timely, cost-effective sharing of clinical and administrative information between a healthcare organization, network providers, and health plans.

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Universal API

This application enables software vendors to interface existing systems with EZ-CAP. This Application Programming Interface (API) is an expert modification tool for developers to format request and response file transactions.

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Cloud Services

Citra Cloud provides an advanced EZ-CAP cloud-based hosting service that gives you everything you need to run EZ-CAP, EZ-EDI, and EZ-NET. Achieve “plug-and-play” access to your application to safeguard your data and control costs.

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eligibility manager

Eligibility Management

Eligibility Manager is a uniquely configurable software solution that makes it easy for IPAs, MSOs, or any population health, delegated group or managed care organization to efficiently manage changes to healthcare member eligibility.

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cap check

Capitation Reconciliation

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.

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Eligibility Management

DataTug is a unique product that knows how to find the information you need quickly and accurately for any health plan. DataTug extracts required data automatically from health plan web sites and ANSI X12 270/271 and other data portals.

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We are Citra

"If you are listening with intent to your clients, you will be a fantastic vendor and a very successful company."

Scott Sanner, CEO

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