Doctor carefully examining an X-ray image

Technology platform

CIM - an administration platform built on collaboration

A secure, cloud-hosted foundation purpose-built for health plan administration. Enrollment, claims, care management, utilization management, and provider workflows in one system, designed to scale as regulation and your business evolve.

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What CIM does

Built for complex delegation, at any scale

Cloud-hosted and secure

Eliminate the need for large IT investments through a fully web-based, cloud-hosted (AWS) platform that is always up to date, always secure, and always available.

Flexible and scalable

Modern application architecture provides the flexibility, scalability, and resiliency you need to grow, deploying across complex communities using a collaborative delegation model.

Real-time analytics

Interactive dashboards, self-service reports, and full relational data access give you visibility into performance, operations, and quality at every level.

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Care management tools

Surveys, assessments, care plans, and HRSN screening tools help your care teams proactively manage member health and close gaps.

Collaborative workflows

Connect providers, administrators, and care teams with shared workflows, plan and provider portal interactions, and a member and provider CRM.

Data integration

Integrate data effectively within a complex ecosystem. CIM evolves to meet ever-changing regulatory and industry requirements.

Trust & security

Compliance you can count on

Our security, privacy, and operational practices are designed to meet the expectations of health plans and regulators, including frameworks such as SOC 1 Type II, SOC 2 Type II, HIPAA, and HITRUST.

SOC 1 Type II
SOC 2 Type II
Health Insurance Portability and Accountability Act
HITRUST Common Security Framework

Supported workflows

Comprehensive administration in a single system

CIM supports the full range of workflows your organization needs to operate efficiently.

✓Enrollment and attribution management

✓Claims and non-claim based payment administration

✓Encounter data reporting and management

✓Plan and provider portal interactions

✓Utilization management (referrals and authorizations)

✓Auto-approval rules engine

✓Member and provider CRM

✓Material fulfillment (EOB, IDN, NOABD)

✓Care management (surveys, assessments, care plans)

✓Data aggregation and integration

✓Premium billing

✓COB / TPL support

✓Appeals and grievance

✓Network management support

Inside the platform

Designed for the people who use it every day

CIM helps users focus on distilling large volumes of complex data into streamlined workflows that prioritize efficiency and leverage underlying automation.

Everything in one view

A claim or authorization opens with its diagnoses, service lines, providers, status, and charges attached. No second system, no export.

Actions where you need them

Notes, correspondence, and edits sit right on the record, one click from the data they relate to.

Familiar from screen to screen

Claims, authorizations, and member records share the same layout and controls, so learning one screen means knowing the rest.

Claim detail

Claim ID:

1234567891011122122

Claim Type:

Institutional

Invoice Number:

1234567778889999

Submitter:

Riverside Clinic

Received Date:

12/01/2021

DX 1: F84.0DX 2: E11.9DX 3: I10DX 4: J45.909DX 5: Z79.899DX 6: F32.1DX 7: M54.5DX 8: R73.03

Referral	Codes	Units	Rev	Dates	POS	Status	EOB	Charges	Write Off
[None]	Proc: RV023HIPPS: 3FC11	30	0023	11/22/2020	12	In Process	[None]	$1,480.00	$0.00
[None]	Proc: 99213HIPPS: 3FC11	1	0510	11/22/2020	11	Paid	EOB-88214	$312.00	$18.40
DR-4471	Proc: J1885HIPPS: 2BA03	2	0250	11/23/2020	21	Denied	EOB-88215	$96.50	$96.50

Preauthorization detail

Preauthorization Details

Episode

1234567888448449

Type of Care

Pharmacy

Auth/Referral Type

Injectable/Infusion Drugs (MSL)

Multi service line

Yesi

Urgency

Standard

Referring Provider

Smith, Tom, MD (NPI: 123456789) - Riverside Clinic

Delivering Provider

Nguyen, Lan, MD (NPI: 987654321) - Cascade Infusion

Facility

Cascade Infusion Center

Diagnosis Code(s)

EDIT

M54.51 Vertebrogenic low back pain
Z79.899 Long-term drug therapy

Diagnosis Code Group(s)

EDIT

Low back pain (view codes)
Default (use specific codes) (view codes)

Services

Code Groups	Service Dates	Procedure Codes	Status	Limits
Default (use specific codes)	12/12/2021 – 12/10/2022	Q5102: Inj., infliximab biosimilar	Approved	Cost to date: $4,820.00Max visits/units: 12
Infusion administration	12/12/2021 – 12/10/2022	96413: Chemo/infusion, first hour	Approved	Cost to date: $1,140.00Max visits/units: 12
Default (use specific codes)	01/04/2022 – 12/10/2022	J1745: Inj., infliximab, 10 mg	[None] use authorization status	Cost to date: $0.00Max visits/units: 1

Live dashboards

Real-time visibility into what matters

Track claims, quality measures, care gaps, and member health across your population in real time, with full access to the data underneath.

Levels of access

Actionable data in the format that fits your needs

From embedded views in CIM to relational data feeds, the right level of access for every audience, from a service lead checking today's queue to an actuary rebuilding the model.

Embedded in CIM

Interactive dashboards and self-service reports built directly into the platform for day-to-day decision-making.

Curated data

Standard reporting extracts, tailored collaborative reporting, and audit support, with guided data training and custom reporting options.

Full relational data

Complete access to data in a relational format, including standard customer data extracts, SQL backups, and pipe-delimited flat files for your reporting warehouse.

Performance insights

Demographics, utilization patterns, and cost trends

Operational insights

Claims oversight, utilization oversight, and service levels

Quality insights

Health outcomes and performance metrics

Operational dashboards

Full transparency and oversight

Claims inventory, turnaround time, call volume, authorization backlog, and quality performance live in CIM, providing the same level of insight used by our own teams.

Plan

Carrier

Group

Practice Office

Measure Year

Reporting Period

iTry the tabs and filters

Measure Overview

Rates against the selected target set · click any measure to ask for it on your data

Met Target || Did not meet Target — 6 of 18 measures at or above target

Measure Type	Measure Name	Passing /Total	Opportunities	Needed to Hit Target
Behavioral	Antidepress Cont	579 / 1,145	566	107	50.57%
Cardiovascular Disease	CVD Statin Adher	149 / 150	1	0	99.33%
Cardiovascular Disease	CVD Statin Disp	150 / 267	117	77	56.18%
CIS	Child Imm Combo3	952 / 1,521	569	0	62.59%
DEN	Dental Ages 1-5 Prev Dent Oral	2,016 / 3,488	1,472	0	57.80%
DEN	Dental Ages 6-14 Prev Dent Oral	4,004 / 6,706	2,702	0	59.71%
Diabetes	Diab Eye Exam	3,272 / 7,303	4,031	1,914	44.80%
	Diab Hba1c	2,304 / 7,303	4,999	4,707	31.55%
	Diab Kidney Eval	715 / 9,390	8,675	4,450	7.61%
	Diab Statin Adher	1,098 / 1,104	6	0	99.46%
	Diab Statin Disp	1,104 / 2,690	1,586	669	41.04%
Hospital Inpatient	ED F/U-High Risk	234 / 496	262	70	47.18%
	TRC-Med Rec	256 / 768	512	59	33.33%
	TRC-Post Discharge	453 / 768	315	192	58.98%
	Unplanned Readmits*	34 / 731	697	28	4.65%
IET	IET Engage	212 / 1,384	1,172	15	15.32%
IET	IET Init	547 / 1,385	838	32	39.49%
IMA	Adol Imm Combo2	722 / 1,876	1,154	0	38.49%

Next step

Let's continue the conversation.

We'd like to share our solutions with you and demonstrate how we can serve your plan, your members, and your needs.

Ask for a tailored demo