Understand the barrier
Work from the needs identified in the clinical care plan.
Community Health Integration · CHIHelp patients move past barriers to care.
Transport, access and other practical barriers can leave a care plan unfinished. MySeema helps connect patients with relevant support, follows up and documents the work under the partner’s clinical supervision.
Patients get personal follow-through
A coordination team you don’t have to recruit
Revenue potential from eligible services
More support, without a new coordination department
We take the follow-through off your team’s list.
Make the connection
Help patients reach appropriate community resources.
Follow through
Check what happened and document what still needs attention.
MySeema carries the coordination.Your clinicians retain clinical decisions, oversight and the required clinical services. Your organization bills eligible services.
See a patient’s path through the service
- A patient cannot get to a needed appointment.
- MySeema helps connect the patient with appropriate transport resources.
- The team follows up and records whether the barrier was resolved.
Illustrative workflow, not an actual patient record or an outcome claim.
Anwar KaziCEO, IntraCare
ACO partnership experience · IntraCare
“Partnering with MySeema allows us to expand critical programs like remote monitoring and care navigation in a way that supports both patient health and our broader population health strategy.”
From MySeema’s broader care-management partnership.
Read about the partnership →CHI codes, at a glance.
Barrier-focused work
Community support
- G0019
- First 60 minutes / month
- G0022
- Each additional 30 minutes
Qualifying work to connect the patient with resources and follow through on the identified needs.
Estimate this base service →Social needs must significantly interfere with diagnosis or treatment of the patient’s medical problem. An initiating visit, trained personnel, consent and required supervision are part of the service.
See the revenue opportunity.
Choose a service and patient count. Adjust the assumptions if needed.
Requirements for the selected estimate
Codes modeled: None selected
One-off services and add-on codes are excluded unless they appear in the selected scenario.
The details, when you need them.
Which patients fit CHI?
- A practitioner identifies unmet social needs that interfere with medical care during an eligible initiating visit.
- Those needs significantly interfere with diagnosis, treatment, or the patient's ability to carry out the medical plan.
- Targeted navigation and connection to community resources can help resolve the specific barrier.
What must be in place before launch?
- Eligible initiating visit and documented upstream driver
- Clear connection between the barrier and medical diagnosis or treatment
- Qualified or trained personnel and partner supervision
- Focused resource plan, patient consent, and documentation workflow
- Controls against duplicate time or work across other care-management services
Conditional on an initiating visit, trained personnel, and partner supervision
Billing details, patient costs and service boundaries
- First 60 completed minutes per calendar month, then a separate 30-minute add-on.
- Initiating practitioner also bills CHI; trained/certified auxiliary personnel may work under required general supervision.
- Document consent, addressed needs, care-related work and time; only one practitioner bills CHI per patient/month.
- May coexist with other necessary care management only when time and effort are separate.
Patient cost sharing and protections depend on coverage and the service. Explain them before consent. Do not use this illustration to charge a Qualified Medicare Beneficiary protected amounts. RHC/FQHC payment rules and Medicare Advantage contracts differ from the national PFS benchmark.
Sources and review notes
Reviewed October 6, 2026. Estimates use the October 2026 CMS rate release.
Put a care team around your patients.
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