Everything You Need to Run Successful Care Programs
VitalEdge combines clinical intelligence, billing automation, and patient engagement in one unified platform designed for RPM, RTM, and CCM programs.
Clinical Workflow
Streamline clinical operations with AI-powered tools that prioritize patient care
Smart Triage Queue
AI-powered prioritization ranks alerts by clinical urgency with risk scores (0-10). Resolve alerts faster with one-click actions and bulk operations.
- Risk scores from 0-10 based on clinical urgency
- One-click resolve, call, or escalate actions
- Bulk operations for efficient triage
Patient Context Panel
View complete patient history at a glance including vitals trends, medications, recent assessments, and active conditions - all in one unified view.
- 7-day vitals trends at a glance
- Active medications and conditions
- Care gaps and assessment history
Care Gap Detection
Automatically identify patients missing preventive care, overdue screenings, or at risk for poor outcomes. Proactive alerts help close gaps before they become problems.
- 8 configurable rule types (HEDIS, custom)
- Nightly automated detection runs
- Auto-close when criteria are met
Billing & Revenue
Maximize reimbursement with automated tracking and intelligent billing tools
Automated Billing Readiness
Real-time tracking of billing eligibility for RPM, RTM, and CCM. Never miss a billable patient with threshold alerts and monthly summaries.
- Real-time CPT code eligibility tracking
- RPM: 16+ days, RTM: 20+ minutes tracking
- CSV export for billing teams
Auto Time Tracking
Automatic start/stop timers capture clinical time with 90%+ accuracy. CPT code suggestions based on activity type ensure compliant billing.
- Auto-start when viewing patient records
- Activity-based CPT code suggestions
- 90%+ time capture accuracy
Patient Engagement
Connect with patients through digital assessments and comprehensive tracking
Digital Assessments
Validated clinical instruments (PROMIS, PHQ-9, GAD-7) delivered via web or mobile. Automatic scoring and trend analysis over time.
- PHQ-9, GAD-7, PROMIS instruments
- Automatic scoring and interpretation
- Trend analysis over time
Patient Portal
Empower patients with secure access to their health data, pending assessments, and care team communication. Installable as a Progressive Web App on Android and iOS, with autosaved offline drafts that submit automatically when connectivity returns.
- Health summary dashboard with vitals and trends
- Complete assessments from any device
- View medications, history, and profile
Clinical Intelligence
Evidence-based recommendations and care pathway orchestration powered by clinical data
Clinical Decision Support
Get real-time, evidence-based recommendations from 8 clinical categorization services. AI-powered insights surface the right guidance at the right time.
- 8 clinical categorization services (BP, Diabetes, HF, COPD, etc.)
- Care pathway orchestration with step tracking
- Priority-ranked recommendations in context
More Powerful Features
Smart Documentation
Pre-built templates for encounter notes, progress summaries, and care plans. Auto-populate from patient data.
Revenue Analytics
Comprehensive dashboards showing billing trends, reimbursement rates, and revenue projections.
Observation Tracking
Capture vitals, symptoms, and patient-reported outcomes from any source - manual entry, device sync, or patient self-report.
Multi-Language Support
Reach diverse patient populations with full internationalization. Available in English, Spanish, German, and more.
Medication Management
Track prescriptions, adherence patterns, and drug interactions with integrated NDC database.
CSV Export & Reports
Export billing summaries, patient lists, and audit logs in standard formats for compliance and review.
Prior Authorization Hub
Streamline prior auth workflows with X12 EDI transactions, Availity/Change Healthcare integration, and real-time status tracking.
Patient Portal (PWA)
Installable on Android/iOS via Add-to-Home-Screen. Patients view health summaries, complete assessments offline with autosaved drafts that sync on reconnect, track medications, and message their care team.
Clinical Decision Support
Evidence-based recommendations from 8 clinical categorization services with care pathway orchestration.
Quality Measure Reporting
18 measures across HEDIS, MIPS, and CMS Star Ratings — diabetes, cardiovascular, preventive, behavioral health, respiratory, medication adherence. MIPS composite scoring with payment-adjustment estimates and nightly population calculations.
Condition-Specific Clinical Dashboards
Eight clinical categorization engines turn raw readings into at-a-glance status, trends, and guidance — ACC/AHA blood pressure, diabetes glycemic control, heart-failure decompensation, COPD, asthma (GINA), AFib (CHA₂DS₂-VASc/HAS-BLED), chronic pain, and autism/ASD.
Patient-Carried PHR + QR Hand-Off
Patients carry their full longitudinal record and hand it to any provider with a revocable QR code — consent-gated and audited, with a FHIR $everything download and surfaced billing opportunities.
FHIR R4 API (Read + Write)
Bidirectional HL7 FHIR R4 endpoints for Patient, Observation, Condition, MedicationStatement, and more. Idempotent, sync-safe imports keep an EHR record current without creating duplicates.
Eligibility Verification
Real-time insurance eligibility and benefits checks (X12 270/271) through Availity and Change Healthcare clearinghouses, with caching and payer-specific configuration — the front end of the prior-authorization workflow.
Program Eligibility Matcher
Before enrollment, instantly see which CMS programs (RPM, RTM, CCM, BHI) a patient qualifies for — evaluated with the same rules engine that governs billing, and aware of provider-credential and same-month concurrency requirements.
Medication Reconciliation
Compare what the pharmacy actually dispensed against what the clinician documented — surfacing undocumented medications and unfilled prescriptions as clinician-actioned candidates. Matching is code-first on RxNorm ingredient with a therapeutic-class fallback, and a claim never silently edits the regimen.
Claims-Based Adherence (PDC)
The official fill-based Proportion of Days Covered measures — PDC-DR and PDC-RASA, both triple-weighted CMS Star measures — computed from pharmacy claims rather than self-report. Patient-reported fills are tracked separately and deliberately fenced out of the official measure. Pluggable claims feed, validated end-to-end against the CMS Blue Button 2.0 sandbox.
Secure Messaging
HIPAA-compliant asynchronous messaging between patients, caregivers, and the care team — one thread per patient, fully audited, with no message content ever written to logs. Clinician review time is captured as billable CCM/PCM/BHI care-management minutes.
Interactive Communication Tracking
CMS requires a live, real-time interactive touchpoint each calendar month before RPM/RTM clinical-time codes can be billed — and text or async chat does not satisfy it. Attested phone and video touchpoints are captured, gate the affected codes automatically, and raise a reminder before the month closes.
Conversational Care Navigation
A patient-facing assistant that answers “explain my record”, “what’s due”, and “what am I eligible for” — grounded strictly in that patient’s own data, descriptive rather than advisory, with a deterministic emergency hand-off, a safe route to the care team for anything clinical, and an always-correct fallback if generation is unavailable.
Funder & Grant Outcome Reporting
Model who underwrites a program — a grant or sponsor — as a first-class entity, separate from who pays the claim, including braided funding across several sources on one enrollment. Hand a funder a revocable, de-identified outcome snapshot scoped to exactly the cohort they paid for, with small-cohort suppression built in.
Network & ACO Rollup
A network organization sees consented, de-identified aggregate outcomes across its member practices — combined quality measures, care-gap closure, and engagement — with tenant isolation preserved by construction and per-member results suppressed below the reporting floor. Member practices consent to participate and can withdraw at any time.
Caregiver-Authored Life Plan
A durable, person-centered plan written by the family — strengths, goals, strategies, triggers, routines, contacts — kept as a private working draft and published to the clinical team as versioned snapshots, so clinicians never act on half-finished edits. Per-section visibility controls what the patient themselves sees.
Informant Assessment Hand-Off
Send a teacher or other outside informant a revocable, single-use QR link to complete one assessment for one patient — no account, no login, minimum-necessary disclosure, consent-gated and fully audited. Results carry the rater's identity, so cross-informant scores are never silently compared.
Comprehensive Care Plan
The CMS comprehensive care plan captured as a real, versioned, clinician-attested artifact with a review cadence — not a checkbox. A missing or out-of-date plan blocks CCM billing automatically, and the month's logged minutes are never quietly billed against an outstanding prerequisite.
RTM for Musculoskeletal Care
Remote Therapeutic Monitoring built for MSK and chiropractic practice — patient-logged pain and home-exercise adherence, range-of-motion and Oswestry functional tracking, alerting on disengagement or functional decline, and device-supply day counting scoped to genuine MSK data.
Security & Compliance
Enterprise-grade security built from the ground up for healthcare
HIPAA Compliant
Enterprise-grade security with end-to-end encryption, role-based access control, and comprehensive audit logging.
Audit Trail
Complete record of all system activity including who accessed what data and when.
Multi-Factor Auth
TOTP-based MFA, backup codes, and social login options for enhanced security without friction.
Role-Based Access
Granular permissions for clinicians, nurses, billing staff, and administrators.
Seamless Integrations
Connect VitalEdge with EHRs, RPM devices, and clearinghouses through our FHIR R4 API and pre-built integrations.
✓ FHIR R4 API live with full read/write operations for Patient, Observation, Condition, and Medication resources
EHR integration ready via FHIR R4 - customer configuration required for Epic/Cerner
Ready to Transform Your Care Programs?
Join healthcare organizations that have increased billing capture by 40% and reduced clinical workload with VitalEdge.