FFS & Self-Funded Risk-Based Management

Integrated Delivery Systems Moving to Risk-Based Models

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

iStock-1130113464-web

 

Our Solutions Enable Integrated Delivery Systems Moving to Risk to:

  • Maximizes 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
  • Controls complex processes involving benefit plans, provider contracts, and member populations
  • Manages value-based care and varied benefit management requirements
  • Comprehensive regulatory and audit support and 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
  • Calculates 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
  • Automates timely and accurate payment to capitated providers based on PMPM expenses
  • Role-based user and security at the module, screen and field level
  • Complete before and after editing; audit trail at the field level

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


aco-icon-NEW

Accountable Care Organizations

Learn More

 

self-insured-employer-icon-NEW

Self-Insured Employers

Learn More

 

health-plan-icon-correct-NEW

Health
Plans

Learn More

 

IPA-icon-NEW

Independent Practice Associations

Learn More

 

integrated-delivery-system-icon-NEW2

Integrated Delivery Systems

Learn More

 

MSO-icon

Management Services Organizations

Learn More

 

Provider-icon_NEW2

Providers

Learn More

 

TPA-icon-NEW

Third Party Administrators

Learn More

 

LOB-ICONS-Commercial

Commercial

Learn More

 

LOB-ICONS-Duals-NEW

Duals

Learn More

 

LOB-ICONS-Medi-Cal

Medi-Cal

Learn More

 

LOB-ICONS-Medicaid

Medicaid

Learn More

 

LOB-ICONS-Medicare

Medicare Advantage

Learn More

 

LOB-ICONS-Pace-NEW

PACE

Learn More

 

LOB-ICONS-Speciality-NEW

Specialty/Carve-Out

Learn More

 

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 

Discover what Citra has to offer. Schedule your demo.

Schedule a Demo