Chronic Care Management Registry
Care Management in the Cloud
A cloud based solution that enables practices to better manage, track and profit from Chronic Care Management (CCM) Services.

The First Chronic Care Management Registry


Identify and Risk Stratify Eligible Patients based on CMS requirements

Upload practice management CSV files, all eligible patients with multiple chronic conditions are loaded into the Registry, and risk stratified. All information is secured by our HIPAA compliant platform, and is made available only to your practice and designated care team members. Patients can enroll and sign Care Management agreements online, in response to email invitations sent by your CCMRegistry account.

Manage and Track

Build & Share Careplans, Track Time and Tasks, Maximize Revenues

Eligible patients are tracked based on accomplishing key milestones such as invitation status, signed agreement, establishing a centralized care plan and clinical work time expended. Time and tasks are recorded for each patient and are used to produce real time dashboards and tracking reports. Create, manage and share centralized care plans with care team members, import and export with EHR systems.

Engage and Communicate

Engage and Communicate with Patients & Care Team Securely

Secure messaging is core to the system, use a web browser or our iPhone app designed for both patients and clincial staff. All communications can be shared with the care team if desired via our included HIPAA compliant, secure messaging technology. The CCMRegistry system has a built-in patient portal so patients can view their messages and Care plans on the web or iPhone app.

Features & Benefits
Chronic Care Management Tool

New Feature: CCM Hotline

Toll free 24/7 Automated Phone Attendant with patient membership card

Routes calls on-screen during business hours & to mobile after hours

Tracks incomming and outgoing calls, staff and clinical work time

Voicemail with SMS notification & secure messaging of call audio/text

CareCliques offers a Web and mobile care management app for caregivers and providers. All parties have a view of the patient's care plan and clinical work / care tasks related to the patient. Built-in secure messaging allows for improved care-coordination and synchronization of care team members using the platform or disparate systems.

The system can import a standard CDA/CCDA clinical summary as the basis for the medical care plan. Psycho-social and functional assessments can be quickly added using custom macros / templates. In combination, this information is used to create a comprehensive, patient centric care plan. Care plans can be shared with disparate EHR systems with just a few clicks.

The system can import 1000's of patients via a simple CSV file import from existing practice management systems. Additionally, CDA/CCDA patient summaries can be exchanged with host E H R systems via directed exchange. Case logs and audit reports are also exportable form the registry in excel/csv format. This minimizes integration issues and provides secure communication of clinical data between systems.

The system can identify appropriate patients within a practice and assist in the process patient enrollment. By processing uploaded practice management system reports, CCM compliant patients are identified. Patient accounts are then created and email invites sent. Patients can enroll and sign requisite agreements online to minimize paper and reduce time and costs.

Quick and easy task recorder tracks care team member's clinical work time attributed to Registry patients. Works on web and mobile, for speed and convenience.

Secure messaging is build-in, communicate with patients and staff via the web and iPhone app. Each care team member has role-based access to the system which allows for collaboration via the centralized care plan. Care plans and messages can also be shared with disparate systems via the Direct Message Protocol.

A comprehensive set of billing reports is included to itemize the patients that have qualified for CMS CCM payments. The report will detail clinical labor time for each patient. Billing managers can further access the patient's task log to clarify any billing or audit questions.

Administrative dashboards highlight current month realized and potential revenue as well as monthly practice revenue trends. Patient hot-lists are provided to identify patient accounts that need attention in order to reach the calendar month clinical work time threshold.

Application Screens

Web app for desktop and iPad
Native iPhone app

5 min Video DEMO of

Pricing and Plans
    • No Net Cost Plan

    • $4 per billable pt per month (10 pt/mo min)

      • Web and Mobile Software Plan - all included
      • Pay only for billable patients - we bill only when you bill
      • No charge for staff or patient access - Invite all care team members
      • Get started in 15 min - upload patients and configure in 4 steps
      • Monthly billing - pay after claims submitted
    • Risk Free 30 day Trial

      Use the Registry for 30 days, risk free. After 30 days, you will be prompted for payment only if you decide to continue using the product.


Contact us to learn more about
CCM Registry and our products

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