Integrated Delivery Systems

Citra helps physicians, hospitals and health systems simplify and streamline business processes for Fee-for-service and Self-funding plans, as well as manage eligibility.  

• Maximize electronic data interchange, accelerated time to value and flexibility for expansion for various payer mixes, including Commercial HMO/PPO, Medi-Cal, Covered California (Exchange), Medicare Advantage and Medi-Medi, including Cal MediConnect product lines
• Control complex processes involving benefit plans, provider contracts and member populations
• Manage value-based care and varied benefit management requirements
• Support 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, C/QM and claims processing
• Calculate member months with 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
• Automate timely and accurate payment to capitated providers based on PMPM expenses
• Utilize role-based user and security at the module, screen and field level
• Complete before-and-after editing of audit trail at the field level

Citra's comprehensive technology platform and advanced population health analytics enable Integrated Delivery Systems to manage FFS and movement to risk-based models.