BloomCore
BloomCore™ Care Management Programs
RN-led, reimbursement-aligned care management infrastructure for modern healthcare practices.
BloomCore™ helps provider organizations deliver structured, longitudinal care management across chronic care, remote monitoring, behavioral health, transitional care, and principal care needs. Each program is designed to support patient engagement, care coordination, documentation workflows, and provider escalation.
Chronic Care Management
Monthly longitudinal support for patients with multiple chronic conditions.
CPT CODES:
CPT 99490, 99439 CPT 99487, 99489 CPT 99491, 99437 when applicableCOMMON DIAGNOSES:
Diabetes, hypertension, COPD, CKD, CHF, depression, obesity, CAD, and other chronic conditions.- ✓ Monthly RN outreach
- ✓ Care plan support
- ✓ Medication and symptom review
- ✓ Provider escalation
- ✓ Time capture support
Remote Patient Monitoring
Device-supported monitoring for patients who need closer physiologic oversight.
CPT CODES:
CPT 99453, 99454 CPT 99457, 99458 CPT 99091 when applicableCOMMON DIAGNOSES:
Hypertension, CHF, diabetes, COPD, obesity, CKD, and respiratory disease.- ✓ Device education support
- ✓ Reading review
- ✓ Exception monitoring
- ✓ Abnormal trend escalation
- ✓ Adherence follow-up
Behavioral Health Integration
Behavioral health support embedded into chronic care and primary care workflows.
CPT CODES:
CPT 99484 General BHI CPT 99492, 99493, 99494 CoCM CPT G2214 when applicableCOMMON DIAGNOSES:
Depression, anxiety, adjustment disorder, behavioral health needs with chronic illness.- ✓ Screening support
- ✓ Emotional wellness check-ins
- ✓ Care coordination
- ✓ Urgent concern routing
- ✓ Registry support
Transitional Care Management
Post-discharge support for patients transitioning home after hospitalization or facility discharge.
CPT CODES:
CPT 99495 CPT 99496COMMON DIAGNOSES:
Post-discharge CHF, COPD, diabetes, CKD, stroke, pneumonia, cardiac events, surgical recovery, and behavioral health discharge needs.- ✓ Discharge follow-up
- ✓ Medication reconciliation support
- ✓ Appointment coordination
- ✓ Red-flag symptom review
- ✓ Provider escalation
- ✓ Readmission prevention support
Principal Care Management
Focused longitudinal support for patients with one serious high-risk condition requiring ongoing care coordination.
CPT CODES:
CPT 99424, 99425 CPT 99426, 99427 CPT G2064, G2065 when applicableCOMMON DIAGNOSES:
CHF, COPD, CKD, cancer, complex diabetes, severe hypertension, advanced neurologic disease, autoimmune disease, high-risk GI disease, and other serious single-condition care needs.- ✓ Condition-specific care plan support
- ✓ Monthly focused outreach
- ✓ Symptom and medication review
- ✓ Specialist coordination
- ✓ High-risk escalation support
- ✓ Documentation and time tracking support
BloomCore™ programs are designed to support provider-led care, improve patient engagement, strengthen documentation workflows, and help practices scale longitudinal care management without building the full infrastructure alone.
Let’s explore which BloomCore™ programs fit your patient population, staffing model, and growth goals.
Request a BloomCare Strategy CallDISCLAIMER: CPT codes and reimbursement pathways may vary based on payer rules, patient eligibility, provider documentation, medical necessity, and billing requirements. BloomCare supports care coordination and documentation workflows but does not guarantee reimbursement.
BloomCare™ Practice Impact Calculator
1. Patient Panel & Programs
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Ready to review your practice’s care opportunity?
Request Strategy CallDISCLAIMER: Projections only. Actual financial returns depend heavily on individual carrier metrics and compliance workflows.
Supported by BloomCare Infrastructure
RN-LED CARE TEAMS
Experienced, compassionate RNs leading every patient interaction.
TECHNOLOGY ENABLED
Workflow tools and dashboards that drive visibility, efficiency, and compliance.
QUALITY & COMPLIANCE
HIPAA-conscious workflows, audit-ready documentation, and QA oversight.
DATA & OUTCOMES
Actionable insights to improve care quality, patient outcomes, and performance.
REIMBURSEMENT ALIGNED
CMS-aligned processes to support proper coding, time capture, and reimbursement.
BETTER CARE. BETTER OUTCOMES.
BloomCare’s BloomCore workflow ensures no patient falls through the cracks—delivering consistent, compassionate care that drives better outcomes, stronger provider relationships, and healthier lives.