Identify Eligible Patients
We help identify Medicare patients who qualify for Chronic Care Management based on eligibility requirements and chronic health conditions.
Chronic Care Management (CCM)
Deliver Better Care Between
Every Patient Visit
Help patients manage chronic conditions with proactive care coordination, continuous engagement, and Medicare-compliant support that improves outcomes while reducing the burden on your healthcare team.
What is Chronic Care Management?
Comprehensive Care Beyond the Clinic
Chronic Care Management (CCM) is a Medicare-supported service designed to help patients living with multiple chronic conditions receive ongoing care between office visits. Through personalized care plans, regular patient engagement, and continuous care coordination, CCM helps improve health outcomes while reducing unnecessary hospitalizations and emergency visits.
Personalized Care Plans
Every eligible patient receives a customized care plan tailored to their chronic conditions, medications, treatment goals, and ongoing healthcare needs.
Monthly Care Coordination
Dedicated care teams provide regular follow-ups, medication reviews, and proactive support to keep patients engaged and their care on track.
Better Long-Term Outcomes
Continuous monitoring and timely interventions help improve patient adherence, reduce avoidable complications, and support healthier lives.
Benefits
Better Care for Patients.
Greater Value for Your Practice.
Chronic Care Management delivers measurable benefits for both healthcare providers and patients by improving care coordination, increasing patient engagement, and supporting long-term health outcomes through continuous, personalized care.
Benefits for Your Practice
Benefits for Your Patients
How It Works
A Seamless CCM Program
From Enrollment to Ongoing Care
Our streamlined Chronic Care Management program combines experienced clinical support, personalized care coordination, and compliant documentation to help your practice deliver better outcomes with minimal administrative burden.
Enroll & Build Care Plans
Patients are enrolled with consent, and personalized care plans are created based on their health conditions, medications, and long-term treatment goals.
Monthly Care Coordination
Our dedicated care team conducts monthly check-ins, medication reviews, patient education, and care coordination to keep patients engaged between office visits.
Documentation & Billing
Every interaction is documented to support Medicare compliance and accurate reimbursement, allowing your practice to focus on patient care instead of paperwork.
Better Outcomes
Patients receive continuous support, providers gain better visibility into chronic conditions, and practices benefit from improved care quality and recurring Medicare reimbursement.
Eligibility Requirements
Is Your Patient Eligible for Chronic Care Management?
Medicare's Chronic Care Management program is designed for patients living with multiple chronic conditions who require ongoing, coordinated care. Patients who meet the following criteria may qualify for CCM services.
Medicare Beneficiary
The patient must be enrolled in Medicare Part B and receive care from a participating healthcare provider.
Two or More Chronic Conditions
The patient must have at least two chronic conditions expected to last 12 months or longer, or until the end of life.
Ongoing Care Needed
The patient's conditions require regular monitoring, coordinated care, medication management, or follow-up support between office visits.
Patient Consent
Patients must provide documented consent before enrolling in a Chronic Care Management program.
Common Chronic Conditions Eligible for CCM
Diabetes
Blood sugar management and ongoing care coordination.
Hypertension
Continuous monitoring to support healthy blood pressure.
Asthma
Personalized treatment support and care planning.
Arthritis
Pain management and mobility-focused care.
Depression
Regular follow-ups and behavioral health support.
Alzheimer
Coordinated care for cognitive health needs.
Cancer
Care coordination throughout treatment and recovery.
HIV/AIDS
Long-term clinical support focused on improving health
Substance Use
Care that supports recovery, treatment plans, ongoing wellness.
What's Included in Our CCM Program
Everything Your Practice Needs to Deliver Better Chronic Care
Our comprehensive Chronic Care Management program combines experienced clinical support, personalized patient engagement, compliant documentation, and Medicare-focused workflows to help your practice deliver exceptional care with confidence.
Faq’s
Chronic Care Management (CCM) FAQs
Find answers to common questions about Medicare Chronic Care Management services, patient eligibility, billing requirements, and how C-Lynx helps healthcare practices improve outcomes while reducing administrative workload.
Medicare Chronic Care Management (CCM) is a reimbursable care coordination program for patients living with two or more chronic conditions expected to last at least 12 months or until the end of life. CCM helps providers deliver ongoing support through personalized care plans, medication management, monthly check-ins, and coordinated communication between visits.
Patients may qualify if they are enrolled in Medicare Part B, have two or more qualifying chronic conditions, require ongoing care coordination, and provide documented consent to participate. Eligibility is determined by the healthcare provider based on Medicare guidelines.
A Chronic Care Management program typically includes comprehensive care planning, medication management, monthly clinical follow-ups, care coordination with specialists, health education, preventive support, electronic health record documentation, and 24/7 access to care management resources.
C-Lynx manages the operational side of Chronic Care Management by identifying eligible patients, coordinating monthly care, documenting clinical interactions, maintaining Medicare compliance, and supporting accurate billing. This allows providers to focus more on patient care while improving practice efficiency.
Chronic Care Management improves patient engagement, strengthens medication adherence, reduces avoidable hospital visits, supports better chronic disease management, and creates a consistent communication channel between providers and patients. Healthcare practices also benefit from improved workflow efficiency and recurring Medicare reimbursement.
Yes. Medicare Part B covers Chronic Care Management services for eligible patients when all Medicare requirements are met. Patients may be responsible for the standard Part B coinsurance unless they have supplemental insurance that covers these costs.
C-Lynx combines experienced clinical care coordinators, proven workflows, secure technology, and Medicare-compliant documentation to help healthcare practices deliver high-quality Chronic Care Management services with confidence. Our goal is to improve patient outcomes while reducing administrative burden for providers.
Getting started is simple. Our team works with your practice to identify eligible Medicare patients, implement a compliant CCM workflow, integrate with your existing processes, and begin delivering coordinated care with minimal disruption to your staff.
Ready to Get Started?
Deliver Better Chronic
Care With Confidence
Partner with C-Lynx to simplify Chronic Care Management, improve patient outcomes, and reduce the administrative burden on your healthcare practice. Our experienced team is ready to help you launch a compliant CCM program with confidence.