Solutions · TCM
Transitional Care Management
Close the loop after a hospital stay — fast.
All programs
Discharge intake, 2-day contact, and 7/14-day visits scheduled and tracked against CPT 99495/99496.
Highlights
- Discharge intake form
- 2-day contact SLA timer
- Visit eligibility tracking
Related programs
Often runs alongside
CCMChronic Care Management
20-minute monthly outreach that meets CMS billing rules.
Track time, document interactions, and bill CPT 99490/99439 with a worklist tailored to chronic-condition patients.
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PCMPrincipal Care Management
Single-condition focus, with the same compliance rigor.
Surface high-need patients with a single complex condition and drive structured outreach against CPT 99424–99427.
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BHIBehavioral Health Integration
Care for whole-person needs, including mental health.
Coordinate behavioral health screening and follow-up against CPT 99484 with shared notes across the care team.
Learn moreStand up TCM on 31M.
We’ll help you migrate from your current process — most teams go live in two to three weeks.