Management Services Organizations

Citra provides the platform allowing any MSO to manage all aspects of managed care management services to Independent Physician Associations (IPAs), TPAs, Health Plans and PACE clients. Differentiated through advanced technology to manage all providers and members across multiple companies, lines of business and contracts through a single powerful platform, addressing the unique needs of each of your clients from small to large, with scale to support millions of members. 

• 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 MSOs managing client IPAs the ability to address all key MSO functions in a single platform with roll-up management and reporting across lines of business and risk models.