Independent Practice Associations

In supporting the delegated model, Citra provides all of the tools necessary to manage the financial risk for healthcare services is transferred from an insurance company to healthcare providers (e.g., physicians or hospitals), such as capitation for all professional services for each health plan member, and variations, such as full or partial risk for hospital services provided to those same members, as well as manage shared risk arrangements for hospital expenses, sharing with the health plan in any differences between actual and budgeted hospital expenses and to supporting  acceptance risk for all healthcare services, global or full-risk capitation.

• 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 IPAs managing their own risk directly, the ability to adress critical fucntions without outsourcing to MSOs or TPAs, ensuring you succeed in all aspects of delegated risk management.