Top 10 Best Transitional Care Management Software of 2026

ThoroughCare is a leading care management platform designed specifically for Transitional Care Management (TCM), Chronic Care Management (CCM), and Remote Patient Monitoring (RPM) in healthcare practices. It automates post-discharge patient follow-ups, medication reconciliation, and billing for TCM CPT codes 99495 and 99496, while integrating with major EHR systems like Epic, Cerner, and athenahealth. The software provides customizable care plans, patient engagement tools, and analytics to improve outcomes and revenue capture.

ChartSpan is a specialized platform offering end-to-end Transitional Care Management (TCM) services, including automated patient outreach, care coordination, and billing support to reduce readmissions and capture Medicare reimbursements. It integrates with major EHR systems like Epic and Cerner, providing providers with a turnkey solution that handles documentation, follow-up calls, and compliance tracking. Designed for scalability, ChartSpan employs dedicated care teams and AI-driven tools to manage post-discharge transitions efficiently.

CareHarmony is a comprehensive platform specializing in Transitional Care Management (TCM), Chronic Care Management (CCM), and Remote Patient Monitoring (RPM), helping healthcare providers reduce readmissions through post-discharge coordination. It offers automated workflows for patient enrollment, care planning, telehealth visits, and billing optimization, with integration into major EHR systems like Epic and Cerner. The software is bolstered by CareHarmony's in-house clinician team that handles much of the patient interaction and documentation, making it a hybrid software-service solution.

Optimize Health (optimize.health) is a cloud-based platform specializing in remote patient monitoring (RPM), chronic care management (CCM), and transitional care management (TCM). It supports post-discharge care by automating patient check-ins, vital sign monitoring via FDA-cleared devices, and care coordination to reduce readmissions. The software streamlines TCM billing with automated documentation for CPT codes 99495-99496, integrates with EHRs like Epic and Cerner, and provides dashboards for care teams to track patient progress during care transitions.

TimeDoc Health is a cloud-based platform specializing in transitional care management (TCM), automating post-discharge patient outreach, follow-up scheduling, and care coordination to reduce readmissions. It integrates with major EHR systems for medication reconciliation, virtual check-ins, and compliance reporting aligned with CMS TCM billing codes. The software emphasizes AI-driven reminders and analytics to optimize care transitions for high-risk patients.

PCOG is a specialized platform for Transitional Care Management (TCM) that automates post-discharge patient follow-ups, medication reconciliation, and care coordination to reduce readmissions. It supports billing for TCM codes 99495 and 99496 with compliant documentation and integrates patient engagement tools like SMS and portals. Designed for physician practices, it provides analytics on care gaps and outcomes to improve transitional care efficiency.

ChronicCareIQ is a remote patient monitoring (RPM) and chronic care management platform that supports transitional care management (TCM) through post-discharge vital sign tracking, patient engagement, and automated billing for CPT codes 99495/99496. It provides healthcare providers with a dashboard for monitoring patient data from connected devices like blood pressure cuffs and glucometers, helping reduce readmissions via timely interventions. The software emphasizes ease of RPM integration into TCM workflows, with AI-driven alerts and care plan automation.

athenahealth's athenaOne platform is a cloud-based EHR and practice management system that supports Transitional Care Management (TCM) through integrated care coordination tools, automated patient outreach, and billing for TCM codes like 99495 and 99496. It enables medication reconciliation, post-discharge follow-ups, and population health management to reduce readmissions. The software leverages interoperability via the athenahealth Network for seamless data exchange with hospitals and other providers.

eClinicalWorks is a comprehensive electronic health record (EHR) and practice management platform that supports Transitional Care Management (TCM) through features like automated patient follow-up scheduling, care coordination workflows, medication reconciliation, and billing for TCM CPT codes (99495/99496). It integrates hospital discharge data, secure messaging, and telehealth to facilitate smooth post-discharge transitions and reduce readmissions. The platform also offers population health analytics to track TCM outcomes and meet quality reporting requirements.

Kareo is a cloud-based practice management and EHR platform designed primarily for independent medical practices, offering tools for billing, scheduling, and patient engagement that extend to Transitional Care Management (TCM). It supports TCM through integrated billing for codes 99495 and 99496, care coordination features, telehealth for follow-ups, and patient portals for post-discharge communication. While versatile for general practice needs, its TCM capabilities are solid but not as specialized as dedicated solutions, making it suitable for practices handling occasional TCM alongside routine operations.