Medicare Chronic Care Management Software 

Our setup process is simple.

We do the work to integrate our HIPAA compliant software and services into your existing workflow. The software helps stratify your patient population to identify patients who may qualify for Care Management (e.g. CCM/RPM).

Our care team and software is proven to improve outcomes and reduce costs while managing enrollment/eligibility, closing Gaps in Care, administrative record keeping and more. With our seamless integration, we have our fingers on the pulse of your patients’ needs.

Here’s how it works:

1

Enrollment

CLH finds and enrolls eligible patients

2

Care Plan / Equipment

CLH creates a custom care plan + provides appropriate hardware

3

RN Tele-coaching / Monitoring

100% RNs provide remote care

4

Reports for Reimbursement

Detailed reports for billing / compliance

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.

Educated and Engaged Patients

Increased Revenue

Nothing beats our platform in action.

All The Ways You Benefit

Full-service
Most Popular
Software + Ops Management
Premium
Software Only
Basic
Gap Closer ™: Tracks and closes Gaps in Care
Patient Targeting & Eligibility
Care Plan Creation
1-Click Care Plan Approval
1-Click Second-by-Second Audit Report
Call Scheduling/Management Dashboard
Staff Time Reports
Auto-time Tracking for CCM/RPM/PCM Eligible Activities
Care Coach Scheduling, Management, & Recruiting
Enrollment & Patient Outreach
Care Plan Distribution to Patients
QA of Billing Reports (Machine & Human)
100% RNs Doing 20+ Minutes of Care Coaching
Zero Staff Burden

Clinical Features

Proven Clinical Results
Multiple independent studies showing statisically significant outcomes, like >80% reductions in ER visits and readmissions in high utilizers and 31% overall cost of care reductions

Gap Closer ™ for Improved Care
Identify, track and close Gaps in Care to improve patient health, quality scores, HEDIS Star ratings and increase revenue

Custom Care Plans from EHR Data
Instantly import existing patient data, or build a care plan from our templates in a snap

1-click Care Plan Approval
Remind, document and track providers’ 1-click approval automatically

1-click Second-by-Second Audit Report
Automatically track all care activities to the second. Access audit trail in 1-click

Consulting from CCM experts at CircleLink*
Benefit from our experience working with hundreds of physicians covering tens of thousands of patients

Care Plan Distribution to Patients
Let us handle the administration of a compliant preventative program

100% RNs Doing 20+ Minutes of Care Coaching*
RN care coaches mean less work for doctors and staff and better quality care coaching for your patients

Administrative Features

Patient Targeting & Eligibility
CircleLink algorithms identity patients appropriate for preventative programs

Care Coach Scheduling, Management & Recruiting
Benefit from our experience working with hundreds of physicians covering tens of thousands of patients

Enrollment & Patient Outreach
CircleLink ambassadors enroll patients

QA of Billing Reports (Machine + Human)
Algorithms plus CircleLink staff ensure you know which patients to bill for each month

Call scheduling/management dashboard
Tools to efficiently schedule and manage a care coaching team at scale

Staff Time Reports
Efficiently manage your human resources

Auto-time tracking for CCM eligible activities
Eliminate effort counting and tallying remote care minutes

Billing & Compliance Reporting
Easily identify which patients are eligible for CCM or other reimbursements

* Only included in the Full-Service Solution

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