CARE-CROS™

Integration: M1 eligibility data (FPL%, insurance status, prescriber NPI) automatically pre-populates Engine 2's patient definition check. A client screened as 340B-eligible in M1 is flagged in the prescription ledger on their first fill — no duplicate entry.

Integration: Plan metal level selected in M2 directly determines the 340B reimbursement rate in Engine 4. A Silver plan with APTC yields commercial reimbursement at 65–70% margin. Each enrollment decision here is a revenue decision.

Integration: Confirming enrollment in M3 writes the new insurance status to the shared client record. Engine 4 reads this update on the next fill — the payer type and reimbursement rate recalculate automatically. Every enrollment confirmation is simultaneously a revenue recognition event in the 340B revenue ledger.

Policy Engine: PA eligibility is verified against your entity configuration before any disbursement is recorded. APTC qualification, FPL range, and PA cap are enforced automatically based on your program rules.

Integration — M5 → E4: A coverage lapse detected in M5 immediately writes a payer status change to the client record. Engine 4 reads this as a revenue leakage event — the expected commercial margin for that client's next fill is reclassified as at-risk. The navigator receives a re-enrollment task and the finance dashboard shows the projected monthly revenue impact of the lapse.

Integration — E3 ↔ M4: Engine 3 reads ADAP premium assistance status from M4 in real time. When a 340B fill is submitted for a client whose M4 record shows they are on ADAP direct purchase AND the fill is being billed to Medicaid, E3 fires a critical duplicate discount flag and simultaneously suspends the M4 payment queue for that client pending navigator review.

Integration — M3/M5 → E4: Payer type for each client updates automatically from M3 enrollment confirmations and M5 lapse alerts. Engine 4 recalculates expected margin per client per fill in real time. For contract pharmacy fills, net margin reflects the actual pharmacy fee structure per Exhibit A ($10 + 8% gross charges, capped per contract terms) — ensuring revenue calculations accurately reflect what the covered entity retains after pharmacy costs.

Full integration: ROPHI auto-populates from the shared data layer — revenue from E4, clinical outcomes from CAREWare sync, ADAP transitions from M3 enrollment log, coverage rate from M5, ED/hospitalization data from outcomes import. The ROPHI ratio updates every time any connected module is updated.

What is Self-Sufficiency? A consumer achieves self-sufficiency when they transition from full dependence on publicly funded assistance to independent responsibility for their healthcare costs — through income growth, skills development, and sustained coverage stability. CARE-CROS tracks this journey with a monthly Self-Sufficiency Score (SSS) across four dimensions: Financial Independence, Coverage Stability, Clinical Stability, and Economic Mobility.

Integration Notice: Cost-sharing is a core medical service per PCN 16-02. Ryan White is payer of last resort — confirm no other source can cover before recording.

How this works: This assessment has four sections (15 minutes to complete). Your answers generate a CARE-CROS Readiness Score (0–100), identify the highest-value platform modules for your program, and produce a personalized ROPHI projection showing your current vs. potential 340B revenue. A shareable link can be generated to send to clients before an introductory call.