Medicare Informatics

Medicare Informatics refers to the use of information technology in the administration of Medicare. The goal of Medicare Informatics is to provide high-quality, efficient, and cost-effective health care services to Medicare beneficiaries by increasing efficiency in the Medicare providers and payors. Our solution combines the analytics, clinical, technology, and administrative services needed to make the transition to value-based care.

The interim goal of Medicare Informatics is to prevent major complication diseases by leveraging patient medical data to support more cost-efficient and high-quality patient care. Our ultimate goal is to build a Cloud-based Big Data Analytics Engine by capturing Medicare related interactions between Patients, Providers, and Payors, analyzing collected data, and making continuous improvement in health costs, quality and outcomes.

We observe CMS regulations and guidance.

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Improve Patient Experience

Continuously improve patient experience by managing patients through the entire care journey.

Total Care Management System »

Continuous Improvement »

Better Health Populations

Improve the access to health care to detect disease early when it is most treatable and curable.

Preventive Services »

Patient Engagement »

Reduce Medical Cost

Improve outcomes through Clinical Decision Support and compensated for healthy outcomes.

Clinical Decision Support »

Value-based Care »

Eligibility Inquiry Service

Real-time access to patient eligibility and benefits information on HIPAA Eligibility Transaction System 270/271.

Eligibility Inquiry (HETS 270/271) »

Electronic Claim Service

[EDI 837] Transmit health care claims and billing payment information electronically, and inquiry claim status.

EDI 837P to CMS-1500 PDF Claim Form »

EDI 837I to CMS-1450 PDF Claim Form »

Preventive Services

Medicare covers a broad range of preventive services to keep you healthy.

Explore Preventive Services »

Provider Lookup

Medicare-enrolled primary care doctors and other healthcare facilities.

CLIA Physician Lookup »

Medicare Physician Compare »

Medicare Hospital Compare »

Medicare Hospice Compare »

Medicare Nursing Home Compare »

ICD-10 Code Lookup

Lookup the ICD-10 CM (diagnosis) and PCS (procedure) medical billing codes.

Diagnosis Code (ICD10-CM) »

Procedure Code (ICD10-PCS) »

General Equivalence Mapping (GEM) »

Diagnosis Related Group (MS-DRG) »

HCPC Code Lookup

Lookup the HCPCS (Healthcare Common Procedures Coding System) codes.

HCPCS Code Lookup »

HCC Risk Adjustment

Hierarchical Condition Category (HCC) and Risk Adjustment is a payment model which identifies individuals with serious or chronic illness and assigns a risk factor score to them based on the individual’s health conditions and demographics. The risk adjustment scores are then applied by CMS to adjust capitated payments made for beneficiaries enrolled in Medicare Advantage Plans.

HCC Risk Adjustment Model »

HCC Risk Score Calculator »

New HCC Risk Score Calculator »

Risk Adjustment Search Tool »

HCC Category »

RxHCC Category »


The Merit-based Incentive Payment System (MIPS) is one of two tracks (MIPS & Advanced Alternative Payment Models) under the Quality Payment Program (QPP), which moves Medicare Part B providers to a performance-based payment system.

Merit-based Incentive Payment System »

  • 2020 MIPS Quality Measure Data »

  • 2020 MIPS PI Measure Data »

  • 2020 MIPS IA Measure Data »

  • 2020 MIPS Cost Measure Data »

Five-Star Rating

CMS employs a Five-Star rating system to quantify quality and performance for certain plans offered to Medicare beneficiaries. This rating system is used to provide a scored assessment of individual quality components, as well as aggregate overall performance of Medicare Advantage (MA) and/or Prescription Drug Plan (PDP)

Medicare Five-Star Rating »