The Performance Improvement Platform for Health Plans

Collaborative workflows for superior clinical outcomes,

health plan performance & member satisfaction


Care Gap Management

The Novillus Care Gap Management Application (CGMA) offers our clients a comprehensive integrated solution to drive the provider group engagement activities essential to achieving performance goals. The CGMA enables bi-lateral clinical data exchange, year-round data capture, care gap closure and provider group performance optimization across all lines of business, including Medicare Advantage, Medicaid, CHIP, ACA.

Through our omni-channel engagement expertise, industry experience, and intuitive technology, payer and provider partners drive improved Medicare Star Ratings, Medicaid program performance and risk adjustment program outcomes.

Automated Clinical Reasoning

Payer teams responsible for medical chart abstraction typically struggle to keep up with the volume of charts that must be reviewed under relentless schedule pressure. Abstractors must match each chart to each member and their care gaps and then accurately determine if all evidence required to satisfy care gap closure criteria is present.

Novillus uses HIPAA-compliant artificial intelligence combined with our years of healthcare experience to create significant efficiencies for abstractors and health plan operations by automating the process of matching charts to each member, analyzing each chart and identifying whether or not evidence satisfying gap closure criteria is present.

Incentive Calculations

Calculus is our powerful solution for modeling and managing provider incentive programs in Medicare Advantage, Medicaid, CHIP, ACA and value-based contracting programs. Calculus can calculate provider performance and incentives on a daily basis over a range of different reward programs. Model-building tools help you create and try out “what if” provider incentive reward packages and generate financial forecasts; using Calculus trend analysis you can then tie the actual results back to the forecasts. Calculus makes it easy to manage provider incentive payments via 835 EFT on whatever schedule you choose – annual, quarterly or monthly.


The Novillus Care Gap Management Application (CGMA) puts actionable, real-time power into the hands of provider groups. The resulting actions create opportunities for faster analysis of emerging provider group activity trends that directly impact reaching your performance goals.

Insights is the Novillus analytics power tool that compliments the CGMA by harnessing provider actions into clearly understandable visualizations. Armed with decision support information powered by Insights, you’ll be able to take decisive actions to reach or exceed your performance goals.


Federal regulations for provider directory accuracy in the No Surprises Act became law on January 1st, 2022. Novillus Clean provides health plans with a solution that delivers 100% accurate provider directory information for regulatory compliance. The solution delivers a continuous audit of provider directory data, including which providers are accepting new patients, the provider’s hours of operation, languages spoken, telehealth encounter options, locations, areas of specialty, and much more.

Strategic Consulting
and Support Services

In addition to our innovative technology solutions, Novillus offers client partners strategic support to help them achieve their program and performance goals. Our team of experts come from various health plans across the country with the knowledge and tactical experience to improve performance for Medicare Star Ratings, Risk Adjustment / Hierarchical Condition Category (HCC) capture, Medicaid, and incentive program structure and health plan provider engagement campaigns and initiatives.

Novillus was founded on our belief that it should be easier for health plans to collaborate with their provider group partners in support of their care of members by providing the information critical to driving improved member outcomes while lifting health plan program performance. Novillus solves complex payer/provider collaboration and interoperability challenges with digital solutions and omni-channel provider group engagement expertise.

Let's start the conversation

Our team is happy to answer your questions. Please fill out the form and we’ll be in touch as soon as possible