Consistent care between appointments. Capture every month.
Only 4% of eligible Medicare patients are enrolled in Chronic Care Management nationally — because running it well is hard. CareAtlas runs it. Your practice captures the reimbursement. Your patients get the monthly contact their conditions actually require.
Every element CMS asks for. Delivered
CareAtlas runs Chronic Care Management end to end — enrollment, monthly touches, care plan maintenance, medication coordination, SDOH screening, documentation, and billing. The qualifying work happens. The claim is clean.
Patients enrolled. Care plan in place
CareAtlas identifies eligible patients on your panel, obtains consent, and builds a personalized care plan before the first monthly touch. No enrollment project on your side. No stalled spreadsheets.
A real person.
A real relationship. Every month
Each patient gets a dedicated, named care navigator who calls them on cadence, asks the right questions, and logs what they learn. 4+ monthly touches on average. Not a scripted operator. Not a chatbot. A person who remembers your patients between calls.
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Meds. Barriers. Access. Captured
Every touch covers medication adherence and refills, and structured SDOH screening (transportation, food, housing, social support). Barriers that would have become an ER visit get identified — and acted on — a month earlier.
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Every qualifying minute, captured as it happens.
CCM's time-based billing requires structured capture of every eligible minute and every required element. HealthQuilt records them in real time. Month-end claims export cleanly into your existing RCM — or are billed by CareAtlas under our affiliated professional corporation, depending on the model you choose.
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