Hybrid Workflow Model™

DEFINITION

Clinicspectrum offers a unique Hybrid Workflow Model™ consisting of innovative product suite and the human touch to decrease cost, increase revenue and streamline healthcare operation management.

DEFINITION DEFINITION

Grow Your Annual Revenue By 15% !!!

Reduce Your Total Cost By 30% utilizingour unique

Hybrid Workflow Model™

DEFINITION COMPONENTS

Hybrid Workflow Model™ consists of:

1. Back-Office Team2. Technology Platform

DEFINITION BACK-OFFICE TEAM

Clinicspectrum offers 10 services with perfect mix of human touch: 1. Accounts Receivable Follow-Up2. Denials & Appeals Management3. Scanning & Indexing4. Appointment Scheduling5. Eligibility Verification With Payers6. Referral Submission & Tracking7. Payment Posting8. Demographics & Claim Entry9. Credentialing10. Medical Transcription Services

ACCOUNTS RECEIVABLE FOLLOW-UP

Two types of claims Follow-Up:

1. No remark claims

2. Last remark claims

Follow-Up process is divided into 3

methods:

1. Online Claims Follow-Up

2. Automated Claims Follow-Up (IVR)

3. Insurance Company Representative

$6.5 per hour* onwards or

$2.25 per follow-up based on

workflow plan

DENIALS AND APPEALS MANAGEMENT

Manages denials of following reasons:

• Authorization Issues

• Referral Issues

• Terminated Insurance

• Coordination of benefits

• Inclusive Procedures

• Partial Payments

• EDI Rejections

• No status and No claim on File

• Workers' Compensation

• PIP cases

$9.5 per hour* onwards


SCANNING & INDEXING

Documents scanned in at thedoctor’s office are categoricallyfiled into the patient charts as perthe requirements of the clinic.Clinical Reports will be given atime and date stamp to allow formore organized indexing. Othertypes of images which can befiled include Insurance card scans,inbound faxes, and hand writtenmedical notes.


20 Cents per scan image based on workflow plan

APPOINTMENT SCHEDULINGThis service is offered to provide doctorsa convenient way to book more patientson a consistent basis. Scheduling is doneas per the requirements of the officewhich include working hours, totalproviders, procedure type, locations, etc.The actual appointments are scheduleddirectly into the provider’s PracticeManagement system. For patients thatare “no shows” or have missed theirappointments a reminder call can begiven on a routine basis to rescheduletheir appointment with the office.

$6.5 per hour* onwards or 45 Cents per live appointment confirmation based on workflow plan 15 Cents per automated appointment confirmation


ELIGIBILITY VERIFICATION WITH PAYERS

There are 3 methods for checking eligibility:

1. Online

2. Automated Claims Follow-Up (IVR)

3. Insurance Company Representative


$2.20 per Benefit Verification based on

workflow plan.

REFERRAL SUBMISSION AND TRACKING

For Specialists who requires a referralor a pre-authorization form theprocess starts with retrieving thepatient demographic information,insurance coverage, procedures to beauthorized, and details of the providerto which they will be referred. Oncethe referral is submitted tracking willbe done to insure that the patient willbe authorized to see the specialist ontheir designated appointment. Thisservice also allows for emergencyreferrals on the date of service asneeded by the office.



It is the single most effective way ofpreventing insurance claim denials. Ourservice begins with retrieving a list ofscheduled appointments and verifyinginsurance coverage for the patients.

PAYMENT POSTINGDEMOGRAPHICS AND CLAIM ENTRY


Explanation of benefits(EOB) payment posting is done as a service using two methods described below:1. Manual Posting 2. Auto Posting

When necessary secondary claimsubmission, patients statementssubmission, and denials tagging canall happen at the time of paymentposting.

$6.5 per hour* onwards or $3.5 per $1000 posting based on workflow plan

For Claim creation the process startswith Demographic entry and insuranceverification. Either through scanningdocuments to our billing team or havingit shipped in packages we collect all theinformation necessary to generate anencounter: demographics, insuranceinformation, and ICD/CPT codes.

Once the information is retrieved the claim can be created using two methods:1. Manual Claim Entry2. Auto generation


CREDENTIALINGMEDICAL TRANSCRIPTION SERVICES


Credentialing is the process of review and verification of the information of a health care provider who is interested in participating with Various Insurances in their County.

Review and verification includes: current professional license(s), current Drug Enforcement Administration and Controlled Drug Substance Certificates, verification of education, post-graduate training, hospital staff privileges and levels of liability insurance.

It is integrated with electronic healthrecords (EHR) ensuring the highest levelof accuracy, privacy and security, to theU.S. Healthcare service providers.

Transcription advantages:1. Quality Assurance2. Integration with HER3. Consistency in Delivery &

Turnaround4. Security & Confidentiality5. Economy6. Infrastructure & Resources

10 Cents per line

DEFINITION COMPONENTS

Hybrid Workflow Model™ consists of:

1. Back-Office Team2. Technology Platform

DEFINITION TECHNOLOGY PLATFORM

Automating Balance Collection Using Technology Platform, Seamless Messaging and Decision Support Rules for Effective Processing Messaging such as Text, Secure Text, Email, Secure Email & Push notifications. Date, time, hour and frequency of calls is auto set-up and notifications are delivered to the debtor simultaneously via our messaging methods.

Reliable Automated Messaging module through PHONE / TEXT or SECURE EMAIL for following issues in Denials and/or need for patient outreach in the areas of: PCP issues. Coordination of Benefit issues. Insurance Termination. Pre-existing condition updates or questionnaire sent to patient's home. High Patient Balances.


A complete HR management module for: Applicant Management Administration Management Employee Management Configuration

A Seamless monitoring tool for enabling: Time Clock functionality Benchmarking and Compliance Self-Benchmarking and Performance Analysis Daily Reporting and comparison with Benchmark for performance Web monitoring for productivity management and Skills enhancements


An automated invoicing module for: Billing and/or EHR subscriptions Payment Plans and/or Membership Processing Template creations, data interfaces through HL7, CSV files and SFTP Auto-generation of invoices with external source synchronizing Sales force productivity examination for better cost/profit analysis Monthly Performance Management by client, sales force and product categories

A complete credentialing profile module for: Management of Credentialing and Re-credentialing activities and reminders Complete Cloud based Documents Management for Credentialing Documents Facility Credentialing Management Milestones Management Insurance Participation Agreements and/or Contract Management Auto-fax, Auto-email and Secure Messaging Capability


A complete client support module for: Client Management Client Support Management Client Notification Management

A complete Workflow Management module for: Cloud based for automating business processes Easy to use interface makes business process up and running in a very short period Allows assigning/re-assigning processes to users Color coded status indicators depicting the status of every process Tracking time consumed for a process


A complete Hospital Rounds module for: Type of Visit Access Management Interface Document Security

A complete Patient Engagement module for: Encourage for Electronic Access of Health Chronic Care Management Create Patient Chart: Auto or Manual Patient List Management eStatement Delivery to All Active Patients on Portal

HOSPITAL ROUNDS MANAGEMENT

908-834-1608

[email protected]

Fb.com/Clinicspectrum

@Clinicspectrum.com

DEFINITION FOR FUTHER INFORMATION

Hybrid Workflow Model™

Healthcare

Transcript of Hybrid Workflow Model™