AI care coordination for primary care clinics
Most CCM calls are billing theater.
Ours find care gaps before they become ER visits.
Before every call, Carenox checks each patient against preventive screening guidelines, overdue labs, medication adherence, and care plan timelines. Then our AI agent has a conversation that actually helps the patient — not a script. Everything is documented for billing, and issues get flagged to your team. You bill CCM and APCM. Your patients get real care coordination.
How It Works
Four steps. Your staff does zero of them.
Step 1
We identify eligible patients
Share your Medicare patient list. We flag every patient eligible for CCM (2+ chronic conditions) and APCM (even 1 condition) — including patients you didn't know were billable.
Step 2
Care gaps are analyzed before the call
For each patient, we check: overdue screenings, missed labs, medication adherence, preventive care timelines. The AI knows what to talk about before it dials.
Step 3
AI calls the patient
A condition-specific voice agent conducts monthly check-ins. Diabetes patients get asked about their A1c. Hypertension patients get asked about their blood pressure readings. It's a real conversation.
Step 4
You get documentation and bill Medicare
Every call generates a structured clinical note, time tracking, and CPT code recommendation. End of month: a billing report with every patient interaction documented and compliance-ready.
If something clinically urgent comes up during a call — the system escalates immediately to your on-call team. AI handles routine care. Your team handles exceptions.
Hear It In Action
Real AI calls. Real patient scenarios.
These are recordings from actual AI agent calls demonstrating how Carenox handles different chronic care management scenarios. Listen to how the agent asks condition-specific questions, identifies concerns, and escalates when needed.
AI agent conducts a complete monthly wellness check-in — medication adherence, symptom screening, vitals, lifestyle, and next appointment confirmation.
Agent checks medication adherence, identifies side effects (itchiness), and confirms refill status — all documented for the care team.
Patient reports shortness of breath. The agent provides safety guidance and flags it for clinical follow-up — demonstrating real-time escalation logic.
Energy level assessment, diet and exercise adherence, sleep quality screening, and appointment confirmation. Includes a mid-call transition to Hindi — demonstrating seamless multilingual support.
Book a demo to hear the agent in any supported language.
These calls demonstrate a subset of our AI capabilities. In production, each call is personalized based on the patient's conditions, care gaps, and history.
The Revenue You're Missing
Two billing programs. One platform.
Most clinics only know about CCM. But APCM (new in 2025) lets you bill for patients with even one chronic condition — a population that was previously generating zero care management revenue.
$60–152 per patient/month. Requires 2+ chronic conditions and 20+ minutes of documented care coordination. Our AI handles the outreach, conversation, and documentation — you review and bill.
$15–117 per patient/month. New in 2025. Covers patients with 0, 1, or 2+ conditions. No time-tracking required — flat monthly payment. This is the untapped revenue most clinics haven't started billing.
Example: A practice with 500 Medicare patients typically has ~200 eligible for CCM and ~300 eligible for APCM. That's up to $250K+ per year in billable care management revenue from your existing panel — with zero additional office visits.
ACCESS Model ready: CMS launched the ACCESS model in July 2026 — paying $90–420 per patient annually for outcome improvement. Our platform is designed to meet ACCESS reporting requirements when you're ready to participate.
Compliance
HIPAA-compliant. Audit-ready. BAA included.
No AI in the billing path — all CPT code logic is deterministic and auditable. We sign a BAA before any patient data touches our system.
Encrypted End-to-End
AES-256 at rest. TLS 1.3 in transit. All infrastructure hosted on BAA-covered cloud providers. Call recordings encrypted and access-controlled.
Complete Audit Trail
Every patient interaction logged with timestamps, duration, and outcomes. 7-year retention. Ready for Medicare audits without your staff pulling files.
Clinical Oversight Built In
Your physician remains the billing provider. AI operates under clinical supervision. Escalation pathways for urgent findings. You stay in control — we handle the legwork.
No Surprises on Claims
CPT code recommendations are rule-based — time thresholds, documentation requirements, eligibility criteria. All verifiable. If Medicare asks why you billed, the answer is in the log.
FAQs
Questions we hear from practices.
They receive a phone call from a voice agent that knows their conditions, their medications, and what screenings are overdue. The conversation is specific to their health — not a generic survey. Patients can ask questions, report symptoms, or request a callback from your office. They opt in and can opt out anytime.
A list of your Medicare patients — a CSV export from your EHR with names, DOBs, conditions, and medications. We handle eligibility screening, care gap analysis, and agent configuration. No complex EHR integration needed on day one. You can be live in days.
The agent recognizes red flags — chest pain, breathing difficulty, suicidal thoughts, adverse drug reactions. It escalates immediately to your on-call team and directs the patient to 911 when appropriate. Every escalation is logged and your staff is notified in real-time.
We retry across different days and times. Patients who consistently don't answer are flagged for your team to address at their next visit. You're only billed for completed interactions — no charge for missed calls.
Yes. We sign a Business Associate Agreement (BAA) before any patient data enters our system. Data is encrypted in transit and at rest. All call recordings and documentation are retained for 7 years in compliance with Medicare record-keeping requirements. Full audit trail on every interaction.
Team
Infrastructure engineering meets healthcare operations.
See how it works for your practice.
15-minute call. We'll review your Medicare panel size, estimate billable patients, and show you a live demo of the AI agent. No commitment.
We respond within 1 business day. No sales pressure.