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 managing eligibility. 

• 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.