Payer programs
Design the program once. Run it per payer contract.
Each payer contract asks for a slightly different program — its own visit
cadence, its own quality measures. Define the program once, with measures
drawn from industry-standard catalogs like HEDIS and Medicare Stars, then
run it per contract, per line of business, per contract year.
- One design, many contracts — the cadence and the measures are
defined once; each payer contract carries its own rules and its own
contract year.
- Month-end is a report, not a project — per contract, the month
shows which patients earned a bill, with the evidence attached: the
readings, visits and activities that actually happened.
- One short, caught in time — patients one requirement away from
a billable month surface as work while there is still month left to
fix it.
At two thousand enrolled patients, month-end in a spreadsheet is a week
of reconstruction — and it grows with the panel.
A bigger panel shouldn't mean a bigger billing team.
Program month
April · mid-month
Payer contract
Medicare Advantage
2026 contract year · its own cadence & measures
Same design, also running
Medicaid MCO
Commercial
-
2,412
enrolled
-
1,904
billable so far
-
137
one short
One short → today's worklist
C
Patient C
9 days left this month · on a care manager's worklist