Delivers ongoing ACCESS care
HealthyConnect enrolls and supports patients, follows progress and shares care updates.
HealthyConnect bills Medicare for its outcome-aligned ACCESS care.
ACCESS · CLINICAL REVIEW PAYMENTS
Who gets paid—and for what?
HealthyConnect delivers ongoing ACCESS care. Eligible clinicians review patient updates, coordinate care and bill separately for qualifying work.
Set up your clinical review workflowThe review economics in brief
HealthyConnect bills for its ACCESS care. Eligible reviewing providers separately bill for completed qualifying review and coordination. The $267 per modeled review hour illustration uses $100 of first-year national-base revenue divided by three reviews of 7.5 minutes each. It includes qualifying onboarding revenue; onboarding and administrative time are additional.
Read the calculation and full assumptions below · Check the official payment sources →
TWO PAYMENT ROLES
Medicare pays for ongoing care and qualifying clinical involvement.
Review and coordinate
The clinician reviews the update, performs qualifying coordination and documents the work.
The eligible billing entity bills separately for co-management.
Review payments compensate qualifying clinical work. A patient introduction or receipt of an update alone does not earn a review payment.
CMS co-management billing guidance ↗FIRST-YEAR PLANNING ILLUSTRATION
$150 per patient.
$267 per modeled review hour.
| First-year illustration | Per patient | 1,000 enrolled patients |
|---|---|---|
| Average qualifying tracks | 1.5 | 1,500 tracks |
| Review and onboarding revenue | $150 | $150,000 |
| Modeled review and coordination time | 33.75 minutes | 562.5 hours |
| Review labor at $80/hour | $45 | $45,000 |
| Revenue less modeled review labor | $105 | $105,000 |
Planning assumptions, not an enrollment or earnings forecast: 1.5 qualifying tracks on average, three completed qualifying reviews per track and qualifying initial onboarding. Each track uses three $30 national base review payments plus $10 onboarding. Multiple tracks require separate qualifying work. Actual payments reflect practitioner type, geography and applicable adjustments.
CMS requires at least five minutes per qualifying review and coordination service; HealthyConnect models 7.5 minutes. The hourly illustration includes onboarding revenue, while its time denominator covers review and coordination only; onboarding takes additional time. The labor calculation covers modeled review labor only. Revenue less that labor is not net profit.
CMS co-management billing guidance ↗ · See your organization’s package ↗
What earns a review payment?
An eligible clinician reviews an ACCESS Care Update, performs related clinical coordination and documents the qualifying work. HealthyConnect bills for its ACCESS care separately; review payments compensate the clinician’s completed service.
FROM CARE UPDATE TO BILLING
Route the care update
HealthyConnect shares progress and relevant information through the agreed workflow.
Complete clinical work
The eligible clinician reviews the update and performs relevant coordination.
Record the service
Document the review, coordination, time and applicable billing requirements.
Submit the qualifying claim
Your billing team submits the appropriate co-management claim and tracks payment.
What might the work look like?
Illustrative example: a HealthyConnect care update includes available blood-pressure trends and a patient-reported medication discrepancy. The clinician reviews the information, reconciles the medication list or coordinates with HealthyConnect as appropriate, and documents the work and time. A qualifying review involves clinical coordination as well as reading the update.
Give the review workflow an owner.
Name the reviewing clinician and the person responsible for tracking completed reviews and billing. Agree where HealthyConnect sends updates so the opportunity becomes a routine part of the workflow.
Updated September 20, 2026. Sources and payment details ↗
Choose your partnership path ↗ · See your team’s responsibilities ↗ · Understand multiple tracks ↗