illuma Care Connections Quality Improvement Programs

Frequently Asked Questions — Health Plans

Who is Illuma?
illuma Care Connections is a care coordination company offering technology enabled services to payers and providers. illuma specializes in closing quality care gaps and improving HEDIS and STAR scores by coordinating care and confirming appointments while actively collecting clinical encounter data for reporting through a proprietary engagement platform and integrated specialty provider network.
How does illuma close gaps in care?
illuma reaches out to members directly via phone, email, text and/or automated voice mails, scheduling exams in real time. Our best in class member engagement strategy and ability to interface with clinical systems drives direct schedule rates significantly higher than the industry standard by removing barriers that typically exist when scheduling members for appointments, all while improving the member experience and increasing attendance rates.
Are all providers eligible to participate?
Yes, illuma Care will work together with any clients’ credentialed providers and/or locations.
How does a PCP get the results of the exam into their electronic medical record system?
Other than a standard referral or order (if required for the screening) there is no additional work for the Physician or staff.
What if the patient has a pre-existing relationship with a provider that is not part of their network?

illuma Care will make every effort to facilitate uninterrupted relationships between patients and providers, even if the imaging center is not participating in the program. illuma Care promotes the continued relationship by means of two separate initiatives.

  1. First Priority Scheduling to Existing Relationships: illuma Care maintains historical relationships between patients and providers. As part of the initial patient setup process, illuma Care accepts special data fields which identify existing relationships between patients and providers. That relationship is available to our care coordination team, so they can offer scheduling to those practices first.
  2. Care Coordinator Scripting: The scripts used by our care coordination team include asking patients if they would like to be scheduled with a practice that they have used before. Priority is given to those practices before a geographically convenient practice is suggested.
How does illuma ensure the claims and codes are captured properly?

illuma trains their providers on proper billing and coding.  Further, illuma captures clinical documentation after the patient visit to catch mis-coded claims quickly so they can be amended and share the clinical data with clients to support ‘supplemental data” for HEDIS audits.

Why illuma?

illuma is the only end-to-end solution that enables real-time scheduling with community-based providers, while collecting supplemental (clinical) data for reporting. With illuma, there is no need to purchase expensive equipment which PCP practices are hesitant to incorporate or send costly mobile units into a community that still require a qualified professional to review images from the screening. illuma eliminates the need for additional readings and equipment by leveraging our expertise and relationship with conveniently located community providers.

Want to Learn More?

Contact us today.  Someone from our team can help you learn more about our quality programs, HEDIS improvements and risk adjustments.