Free CCM Eligibility Identification for Your Medicare Population
Your team is already doing the chronic care work. Eligibility identification is where making it billable starts.
Built for Organizations Ready to Grow their CCM Program – Not their Headcount
If your organization already cares for a large Medicare or Medicare Advantage population, there’s a good chance you’re missing reimbursable care management opportunities already hiding within your patient panel. Clinii helps healthcare organizations identify eligible patients, expand care management programs, and capture more Medicare revenue—without adding staff or replacing existing workflows.
This solution is ideal for:
- Primary care practices
- Federally Qualified Health Centers (FQHCs)
- Rural Health Clinics (RHCs)
- Cardiology practices
- Pain management practices
- Internal medicine groups
- Multi-specialty physician organizations
- Independent Physician Associations (IPAs)
- Accountable Care Organizations (ACOs)
- Health systems and medical groups
Clinii integrates with 30+ leading EHRs, including athenahealth, eClinicalWorks, AdvancedMD, Greenway Health, Practice Fusion, Veradigm, and NextGen, allowing organizations to uncover new care management opportunities without disrupting the systems and processes already in place.
Why It Matters
Eligibility is where revenue leakage starts
Most organizations with a large Medicare and Medicare Advantage population are already doing chronic care management work — it just isn’t connected to a program, an enrolled patient, or a billable month. That gap starts at eligibility: patients who qualify for CCM, PCM, APCM, or another program but were never identified in the first place.
Clinii helps teams see that opportunity before outreach, enrollment, or billing operations begin — so the work already happening has somewhere to go.
What This Looks Like in Practice
The Care Management Revenue Assessment
A organization shares EHR data covering its active Medicare and Medicare Advantage patients. Clinii reviews diagnoses, insurance coverage, and program criteria, then returns a structured Care Management Revenue Assessment: how many patients qualify for CCM, how many qualify for PCM, APCM, or RTM instead, and where programs overlap.
This is the same eligibility engine Clinii runs behind the scenes at scale — it’s reviewed over 700,000 patients to date and currently supports 120,000+ active lives across 80+ billing codes, with a 95% qualification accuracy rate on program fit.
- STEP 1 Your Patient Population
- STEP 2 AI Reviews EHR Data
- STEP 3 Eligibility Analysis
- STEP 4 Revenue Opportunity Assessment
- RESULT Prioritized Patient List
Benefits
Find qualified patients faster
Reduce manual chart review and identify patients who may qualify for reimbursable programs. 
Prioritize outreach
Focus staff and automation on patients with the clearest program fit. 
Estimate revenue opportunity
Understand potential care program revenue before enrollment begins. 
Support multiple programs
Identify eligibility across CCM, PCM, APCM, CPM, RTM, BHI, and TCM, not just one. 
95% qualification accuracy
Built on an eligibility engine already used across 120,000+ active patient lives. 
50% faster enrollment
A clean, prioritized eligibility list is what makes faster enrollment possible in the first place. What Happens After Eligibility
Straightforward pricing, even after the free assessment
The Care Management Revenue Assessment itself is free and comes with no commitment. If you move forward, Clinii is priced at $5 per compliant patient per month — if a patient doesn’t meet compliance requirements in a given month, there’s no fee for that patient. You’re not paying a flat fee regardless of outcome; you’re paying for compliant, billable months.
Find out how much Medicare care management revenue is sitting inside your existing patient population.
Request Your Care Management Revenue AssessmentFAQ
What is Free CCM Eligibility Identification?
It’s a service Clinii provides to determine which patients in your Medicare and Medicare Advantage population qualify for Chronic Care Management or other Medicare care management programs, based on diagnoses, insurance coverage, and program-specific criteria.
Which care programs does Clinii check eligibility for?
Clinii checks eligibility across CCM, PCM, APCM, CPM, RTM, BHI, and TCM.
Is this only for CCM, or other programs too?
Despite the name, the assessment isn’t limited to CCM. Clinii evaluates your population against every Medicare care management program it supports and shows you where patients overlap across programs.
Is there a cost to get the eligibility analysis?
No. The Care Management Revenue Assessment is free with no commitment. If you move forward afterward, Clinii is priced at $5 per compliant patient per month — there’s no fee for patients who don’t meet compliance requirements that month.
What data does Clinii need to identify eligible patients?
Clinii uses available patient demographics, insurance coverage, and diagnosis or problem-list data (ICD-10) from your EHR to evaluate program fit.
Does this work with my EHR?
Yes. Clinii connects with common EHRs already used by most physician groups and specialty groups, including athenahealth, eClinicalWorks, AdvancedMD, Greenway, Practice Fusion, Veradigm, and NextGen.
Does this work for specialty groups, not just primary care?
Yes. Cardiology, pain management, and multi-specialty groups with a meaningful Medicare and Medicare Advantage population are common fits, alongside primary care.
What if we're already running CCM manually for some patients?
That’s fine. The assessment surfaces additional patients you may have missed rather than changing how you manage patients already enrolled.
How accurate is the eligibility assessment?
Clinii’s eligibility engine runs at a 95% qualification accuracy rate and has been used across more than 700,000 patients to date.
How long does an eligibility assessment take?
Turnaround depends on population size and how patient data is shared, but most organizations receive their Care Management Revenue Assessment within a few business days.
