Deliver CCM consistently. Generate recurring revenue. Run it with your own team.
Chronii uses AI voice and text outreach to reach patients, schedule CCM check-ins, and warm-transfer available patients to your staff. It also turns care plans and clinical notes into patient-specific work, while automatically capturing the human CCM activity completed inside the EHR.
Book a demoDo it without relying on spreadsheets, manual timers, or repeated cold calls.
Chronii
Today's CCM Work
Today's task
Review home blood pressure readings and discuss medication adherence.
Source: Care plan and office note from July 18
Human call connected
10:42 AM
Current call duration
6:00 min
Enrollment review
Chronii lives inside the EMR you already use
When no chart is open, the widget shows your team's Today's CCM Work list. Open a patient's chart, and it switches to that patient's session: tasks teed up for the visit, a live timer, the care plan, an audit log of the active session, and the attestation staff need to complete.
- Tasks teed up for the patient appear right in the chart
- A live timer and session audit log are captured automatically
- Staff review the care plan and complete the attestation without leaving the EHR
Compatible out of the box with
Maria Johnson
DoB 03/14/1964 · MRN 83347583
Encounters
Problem list
Medications
Referrals
Maria Johnson
9:24Tasks for this visit
Phone call
Step 1 · Attest this is CCM time
A better way to operate CCM every day
Chronii coordinates the work before, during, and after each patient interaction. Your team begins the day with a clear patient worklist, patients who are ready to engage, and the clinical context needed for the conversation.
Connect staff with patients who are ready to talk
Chronii calls through the patient worklist, determines whether each patient is available, and connects interested patients to an available staff member. When a patient cannot talk, Chronii schedules a better time. Scheduling works both ways: Chronii books outbound check-in calls and can also field inbound calls from patients looking to reach the practice. Your nurses spend less time repeatedly dialing patients and reaching voicemail.
AI outreach
Patient answered
Patient available
“Maria is available to speak now.”
Warm transfer
Nurse accepted · time capture started
Know what needs to be done for every patient
Chronii reviews the approved care plan and available clinical notes to suggest patient-specific work for the month. Every suggested task includes the reason it was generated and the clinical information supporting it. A human reviews each suggestion before it becomes part of the worklist.
Follow up on home blood pressure readings
Reason: The last office note requested a two-week blood pressure log.
Care-plan goal: Maintain average blood pressure below the clinician-defined target.
Choose which actions to take
Continue the care plan between visits
Chronii sends conversational text outreach about specific clinical and administrative topics selected from the patient's approved work plan. Instead of sending generic monthly messages, the outreach can focus on medications, symptoms, laboratory testing, referrals, appointments, scheduling, care-plan goals, or other patient-specific needs. Staff can also join the same SMS thread to text the patient directly, and always review responses to decide what action to take.
Hi Robert, Dr. Smith's office is following up about the new blood pressure medication discussed at your last visit. Have you been able to take it each day?
I missed it twice this week because it makes me dizzy.
Thank you. I'll share that with your care team. Would you like someone from the office to call you?
Yes, tomorrow afternoon.
Patient reports dizziness and missed doses
Human review required · Next: Schedule care-team call
Capture CCM work while staff remain in the EHR
Chronii detects patient-chart sessions and records the context behind the work, including the EHR views accessed, orders placed, and referrals completed. It also records human-connected call time. Staff review, adjust, and approve each proposed time entry before it is included in the patient's monthly CCM total.
Maria Johnson
Started 11:04 AM
Current duration: 9 minutes
- Encounter viewed (2 min)
- Referrals viewed (1 min)
- Orders viewed (2 min)
- Referral order placed: Nephrology
The complete CCM workflow, connected
Chronii supports the patient from initial identification through monthly billing review. The difference is that every step feeds directly into the work your staff performs each day.
Identify
Find potential CCM patients
Chronii reviews available age, diagnosis, problem-list, and payer information to surface patients who may qualify.
Output: Potential patient list
Practice action: Review and attest to clinical eligibility
Confirm
Confirm readiness
Record insurance verification, initiating-visit status, billing practitioner, and clinical eligibility.
Output: Patient ready for enrollment
Practice action: Confirm the applicable requirements
Enroll
Automate the enrollment conversation
Use conversational voice and text outreach to explain CCM, provide the required disclosures, and record the patient's decision.
Output: Enrollment and consent record
Practice action: Review and activate the patient
Plan
Create the care plan
Chronii drafts a patient-specific care plan from available clinical information.
Output: Draft care plan with source information
Practice action: Review, edit, and approve
Generate monthly work
Turn the care plan into action
Chronii identifies relevant patient-specific tasks using the approved care plan and recent clinical notes.
Output: Prioritized monthly worklist
Practice action: Approve, modify, or reject suggested tasks
Reach and connect patients
Engage patients by text and voice
Chronii conducts structured clinical outreach, schedules check-ins, and warm-transfers available patients to staff.
Output: Completed patient interactions and responses
Practice action: Provide the clinical care and follow-up
Capture human activity
Track CCM work automatically
Chronii captures EHR sessions, human calls, manual entries, and activity-level supporting evidence.
Output: Proposed CCM time record
Practice action: Review, adjust, and approve the time
Prepare billing and audit records
Bring the month together
Chronii organizes approved human time, documentation, consent, care-plan status, and monthly activities.
Output: Billing recommendation, export, and audit report
Practice action: Make the final billing decision and send the export to the existing biller
Identify
Find potential CCM patients
Chronii reviews available age, diagnosis, problem-list, and payer information to surface patients who may qualify.
Output: Potential patient list
Practice action: Review and attest to clinical eligibility
Confirm
Confirm readiness
Record insurance verification, initiating-visit status, billing practitioner, and clinical eligibility.
Output: Patient ready for enrollment
Practice action: Confirm the applicable requirements
Enroll
Automate the enrollment conversation
Use conversational voice and text outreach to explain CCM, provide the required disclosures, and record the patient's decision.
Output: Enrollment and consent record
Practice action: Review and activate the patient
Plan
Create the care plan
Chronii drafts a patient-specific care plan from available clinical information.
Output: Draft care plan with source information
Practice action: Review, edit, and approve
Generate monthly work
Turn the care plan into action
Chronii identifies relevant patient-specific tasks using the approved care plan and recent clinical notes.
Output: Prioritized monthly worklist
Practice action: Approve, modify, or reject suggested tasks
Reach and connect patients
Engage patients by text and voice
Chronii conducts structured clinical outreach, schedules check-ins, and warm-transfers available patients to staff.
Output: Completed patient interactions and responses
Practice action: Provide the clinical care and follow-up
Capture human activity
Track CCM work automatically
Chronii captures EHR sessions, human calls, manual entries, and activity-level supporting evidence.
Output: Proposed CCM time record
Practice action: Review, adjust, and approve the time
Prepare billing and audit records
Bring the month together
Chronii organizes approved human time, documentation, consent, care-plan status, and monthly activities.
Output: Billing recommendation, export, and audit report
Practice action: Make the final billing decision and send the export to the existing biller
What changes for your care team
Before Chronii
Beginning of the day
- Open a spreadsheet
- Decide who to call
- Search the chart for a reason to follow up
- Call patients one at a time
- Reach voicemail repeatedly
- Ask patients to call back
- Manually arrange a better time
During the work
- Start and stop a separate timer
- Search multiple EHR views
- Manually create a summary
- Track minutes in a spreadsheet
- Remember which patients still need work
At the end of the month
- Reconcile multiple time sources
- Identify missing documentation
- Calculate billing thresholds
- Prepare information for the biller
- Reconstruct the record when questions arise
With Chronii
Beginning of the day
- Open a prioritized CCM worklist
- See why each patient needs follow-up
- Review patients who responded by text
- Accept warm transfers from available patients
- See scheduled calls for the day
During the work
- Open the patient chart
- Complete the clinical work
- Let Chronii capture the session context
- Review the automatically drafted note
- Approve or adjust the time
At the end of the month
- See which patients are ready for billing review
- Review the suggested code
- Resolve any flagged issues
- Export the billing record
- Retain the patient-level audit history
Designed to increase the capacity of your existing team
Chronii is not intended to replace the clinic's care team. It is designed to remove the repetitive operational work that limits how many patients the team can manage effectively.
Fewer unsuccessful calls
AI voice outreach and scheduling reduce the time staff spend repeatedly calling patients who are unavailable.
More useful patient interactions
Staff begin each conversation with a patient-specific reason for outreach and the relevant clinical context.
More complete time capture
EHR sessions and human call time are brought into one reviewable monthly record.
More consistent monthly execution
The worklist, patient outreach, documentation, and billing status are managed in one connected workflow.
See what a consistent CCM program could generate
Estimate recurring monthly and annual revenue from your existing patient panel. Adjust the assumptions to match your practice, payer mix, and typical billing pattern.
Your panel
Estimated recurring revenue
120
Enrolled patients
40%
Of eligible panel
Based on 9 of 12 months billed per enrolled patient
Estimates use approximate national average non-facility Medicare reimbursement for CPT 99490 (first 20 minutes of clinical staff time per month) and CPT 99439 (each additional 20 minutes). Annual figures assume the average enrolled patient is successfully billed for the number of months you set below, not all 12, to account for mid-year enrollment, missed thresholds, and disenrollment. Actual reimbursement varies by payer, contracted rate, locality, and MAC. For illustration only — not a guarantee of revenue.
See what a CCM workday looks like with Chronii
Walk through AI patient outreach, warm transfers, patient-specific tasks, EHR time capture, and monthly billing preparation.
Book a demo