Chronic Care Management
Chronic Care Management (CCM) provides non-face-to-face care coordination services for Medicare beneficiaries with two or more chronic conditions. Our platform streamlines care planning, medication reconciliation, 24/7 patient access, and provider coordination. With automated time tracking and comprehensive documentation, you can deliver high-quality care management while meeting all Medicare billing requirements for CPT codes 99490 and 99439.
Key benefits
Medicare CPT 99490 and 99439 billing
Automated 20-minute time tracking
Comprehensive care plan templates
Medication management tools
24/7 patient access documentation
Multi-provider coordination
Essential capabilities
The main features included in this program.
Chronic Care Management
Coordinated care for patients with multiple chronic conditions including comprehensive care planning and medication management.
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EMR Integration
FHIR and HL7 integration with existing EMR/EHR systems for seamless data exchange.
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Time Tracking & Compliance
Automated time tracking for Medicaid services ensuring accurate documentation for reimbursement.
Web-Based Platform
Cloud-based RPM software accessible from any device, designed specifically for home care workflows.
Provider Reporting
Comprehensive provider dashboards and performance reports for quality improvement and billing optimization.
All features (16)
The complete list of capabilities included in this program.
Care Team Collaboration
Shared notes, time tracking, and task automation for seamless care coordination.
Learn more → EMR Integration
FHIR and HL7 integration with existing EMR/EHR systems for seamless data exchange.
Learn more → Time Tracking & Compliance
Automated time tracking for Medicaid services ensuring accurate documentation for reimbursement.
Web-Based Platform
Cloud-based RPM software accessible from any device, designed specifically for home care workflows.
Audit-Ready Documentation
Comprehensive reporting and documentation that meets TMHP audit requirements for Medicaid billing.
Smart Multilingual Messaging
AI-powered multilingual communication that automatically translates messages to reach diverse patient populations.
HIPAA Secure Platform
Enterprise-grade security with full HIPAA compliance, end-to-end encryption, and regular security audits.
Patient Onboarding
Streamlined enrollment process with guided setup, device pairing assistance, and patient education materials.
Digital Consent Forms
Paperless consent management with electronic signatures, secure storage, and automated compliance tracking.
Medication Tracking & Reconciliation
Comprehensive medication management with adherence tracking, interaction alerts, and automated reconciliation.
Mobile Access
Full-featured mobile apps for iOS and Android enabling care teams to monitor and respond from anywhere.
Multi-Language Support
Support for 20+ languages including Spanish, Vietnamese, and other common patient languages.
Data Export Tools
Export patient data, billing reports, and compliance documentation in multiple formats (PDF, CSV, Excel).
Provider Reporting
Comprehensive provider dashboards and performance reports for quality improvement and billing optimization.
Redundancy
Cloud-based infrastructure with automatic backups and 99.9% uptime guarantee for reliable 24/7 access.
Chronic Care Management
Coordinated care for patients with multiple chronic conditions including comprehensive care planning and medication management.
Learn more →How you get paid
Built for these providers
Primary Care Providers
Internal Medicine Practices
Family Medicine Practices
Geriatric Care Practices
Medicare Accountable Care Organizations