eKlotho Nexus Documentation
Comprehensive documentation for the eKlotho Nexus Healthcare Administration Platform. This documentation covers all 26 modules (179 pages), API connectivity requirements, and organization-specific deployment guides for 8 healthcare organization types.
Quick Links
Organization Deployment Guides
IPAs
Independent Practice Associations — physician network contracting
PHOs
Physician Hospital Organizations — hospital-physician joint ventures
ACOs
Accountable Care Organizations — value-based care delivery
MSOs
Management Services Organizations — administrative services
TPAs
Third-Party Administrators — claims processing for self-funded
MCOs
Managed Care Organizations — managed health plan operations
FQHCs
Federally Qualified Health Centers — community health centers
Health Plans
Commercial, Medicare Advantage, and Medicaid coverage
Module Documentation
Administration
Centralized system administration for the eKlotho Nexus platform, providing security management, user governance, EDI co...
Analytics & Reporting
Comprehensive analytics platform providing executive dashboards, clinical quality metrics, financial performance analysi...
Prior Authorization
End-to-end prior authorization management including submission, clinical review, auto-approval rules, denial management,...
Claims Management
Complete claims lifecycle management from submission through adjudication, payment, and reconciliation — supporting prof...
Enrollment & Eligibility
Member enrollment lifecycle management from initial enrollment through eligibility verification, plan assignment, and di...
Financial Management
Comprehensive financial management including actuarial analysis, medical loss ratio tracking, payment processing, premiu...
Provider Network Management
End-to-end provider network lifecycle management including credentialing, contracting, directory maintenance, network ad...
Care Coordination
Comprehensive care coordination platform supporting case management, chronic disease management, care transitions, and i...
Clinical Tools
Clinical assessment tools, care plan management, and patient screening protocols supporting evidence-based care delivery...
Medication Management
Medication lifecycle management including prescription tracking, drug interaction checking, adherence monitoring, and fo...
Patient Management
Comprehensive patient/member record management spanning demographics, clinical history, insurance, care teams, and commu...
Population Health
Population health analytics and management platform supporting HEDIS quality measures, risk stratification, predictive a...
Vitals & Remote Patient Monitoring
Patient vital signs monitoring including remote patient monitoring (RPM) device integration and real-time alert capabili...
Alerts & Notifications
Multi-channel alert system for clinical emergencies, medical notifications, and operational alerts with configurable esc...
Appointments & Scheduling
Patient appointment scheduling including calendar management, schedule optimization, and telehealth integration....
Billing & Insurance
Billing operations including insurance verification, payer management, and revenue cycle overview....
Communication & Outreach
Multi-channel communication platform for patient outreach, health campaigns, and organizational messaging....
Compliance
Regulatory compliance monitoring, tracking, and reporting across all applicable standards and requirements....
Document Management
Enterprise document management including storage, versioning, OCR scanning, and document workflow....
Employer Groups
Employer group management for commercial health plans including group setup, census management, COBRA administration, an...
FQHC Management
Specialized Federally Qualified Health Center management including 340B drug pricing, PPS payment tracking, sliding fee ...
Grievances & Appeals
Member and provider grievance management including intake, investigation, appeal processing, and resolution tracking wit...
Products & Benefits
Insurance product management including benefit design, accumulator tracking, plan comparison, and CMS product submission...
Regulatory Management
Regulatory compliance management across CMS, NCQA, and state requirements including filing calendars, submission trackin...
Risk Pools & Shared Savings
Provider risk arrangement management including capitation pools, withhold programs, shared savings calculations, and set...
Multi-Tenant Management
Multi-tenant platform management for organizations serving multiple client entities with isolated data, shared infrastru...