Accurate Eligibility

Automated verification using unique real-time batch process through direct and gateway connection to payers.

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Comprehensive Enrollment and Eligibility Update Management

eligibility manager

Eligibility Manager® is a uniquely configurable software solution that makes it easy for IPAs, MSOs, or any population health, delegated group or managed care organization to efficiently manage changes to healthcare member eligibility. Users can effortlessly reconcile their own data against data from all payers. The program takes as input a full or partial list of members from a health plan, and creates a list of membership changes.

What makes Eligibility Manager superior to other eligibility management programs are two main strengths. First, its unique design allows for implementation of custom processing for any health plan data format, health plan data issues, and client business rules. And second, powerful yet easy-to-use auditing tools allow eligibility analysts to quickly find and correct data issues.

These special features enable Eligibility Manager to:

  • Provide a high level of control over your eligibility data
  • Inload and audit eligibility quickly and accurately
  • Identify members that have dropped off the health plan's list
  • Incorporate years of experience in interpreting health plan data files 
  • Manage any number of entities' contracted eligibility with any number of plans

In addition, Eligibility Manager is fully customizable to load and export eligibility data in any format, including ANSI X12 HIPAA formats. Combined with DataTug™, users can save hours with automatic online eligibility verification.

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Automated Eligibility Data Verification!

DataTug™ is a unique product that knows how to find the information you need quickly and accurately for any health plan. DataTug can save you hours of time every day, saving you money and increasing your productivity. DataTug extracts required data automatically from health plan web sites and ANSI X12 270/271 and other data portals.

DataTug provides real-time batch processing of eligibility verification. It has a flexible data interface that allows for searches of members provided in various file formats, or through its proprietary API.

DataTug makes it easy for medical groups to verify eligibility for:

  • Members with pended healthcare claims.
  • New members in new claims.
  • For California medical groups, monitoring eligibility to comply with Assembly Bill 1324.
  • Discrepancies found in Eligibility Manager® or Cap Check™.

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Accountable Care Organizations

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Self-Insured Employers

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Health
Plans

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Independent Practice Associations

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Integrated Delivery Systems

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Management Services Organizations

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Providers

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Third Party Administrators

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Commercial

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Duals

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Medi-Cal

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Medicaid

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Medicare Advantage

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PACE

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Specialty/Carve-Out

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Core Administration

EZ-CAP is a comprehensive claims and benefit administration system, managing all functions of a managed care organization in a single integrated platform.

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Utilization/Case/Care Management

EZ-CARE is a dedicated care management module supporting our clients clinical teams’ focus on managing risk, quality of care, reducing costs, and improving patient/member experience. This complete, easy-to-use case management application is designed for the unique workflows of the nurses, doctors, case managers and healthcare administrators engaged in care management roles.

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Analytics

EZ-INFO provides a complete, end-to-end population health platform for delegated IPAs, MSOs and Health Plans managing patients at risk. This solution combines everything from clinical and claims data to biometric and social information in a single location for actionable data, such as managing HCCs, HEDIS, STARS, etc., making program management simple, allowing you to effortlessly maximize revenue and reduce the future cost of care.

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Electronic Data Interchange

EZ-EDI offers the latest advancement in electronic data interchange (EDI) to easily retrieve information and perform transactions in real-time directly into EZ-CAP, without going through a clearing house.

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Provider Portal

This internet portal facilitates timely, cost-effective sharing of clinical and administrative information between a healthcare organization, network providers, and health plans.

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Universal API

This application enables software vendors to interface existing systems with EZ-CAP. This Application Programming Interface (API) is an expert modification tool for developers to format request and response file transactions.

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Cloud Services

Citra Cloud provides an advanced EZ-CAP cloud-based hosting service that gives you everything you need to run EZ-CAP, EZ-EDI, and EZ-NET. Achieve “plug-and-play” access to your application to safeguard your data and control costs.

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Capitation Reconciliation

Cap Check is an essential tool for medical groups with capitated contracts to verify that they are receiving correct payments. By reconciling actual payments with expected payments on a member/month basis, you can verify whether you are being paid correctly, and make corrections when you are not.

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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.

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