Clinicspectrum provides a hybrid workflow model that combines technology and human services to enhance healthcare operations, aiming to increase revenue by 15% and reduce costs by 30%. The model includes a back-office team that offers various services such as accounts receivable follow-up, denials management, and appointment scheduling, while leveraging a technology platform for automation and efficiency. Their comprehensive approach ensures streamlined processes in patient management, eligibility verification, credentialing, and billing, ensuring effective healthcare delivery.

3. 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.

4. DEFINITIONDEFINITION
Grow Your Annual Revenue By 15% !!!
Reduce Your Total Cost By 30% utilizing
our unique
Hybrid Workflow Model™

5. DEFINITIONCOMPONENTS
Hybrid Workflow Model™ consists of:
1. Back-Office Team
2. Technology Platform

6. DEFINITIONCOMPONENTS
Hybrid Workflow Model™ consists of:
1. Back-Office Team
2. Technology Platform

7. DEFINITIONBACK-OFFICE TEAM
Clinicspectrum offers 10 services with perfect mix
of human touch:
1. Accounts Receivable Follow-Up
2. Denials & Appeals Management
3. Scanning & Indexing
4. Appointment Scheduling
5. Eligibility Verification With Payers
6. Referral Submission & Tracking
7. Payment Posting
8. Demographics & Claim Entry
9. Credentialing
10. Medical Transcription Services

8. 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
DEFINITIONBACK-OFFICE TEAM

9. SCANNING & INDEXING
Documents scanned in at the
doctor’s office are categorically
filed into the patient charts as per
the requirements of the clinic.
Clinical Reports will be given a
time and date stamp to allow for
more organized indexing. Other
types of images which can be
filed include Insurance card scans,
inbound faxes, and hand written
medical notes.
$6.5 per hour* onwards or
20 Cents per scan image based
on workflow plan
APPOINTMENT SCHEDULING
This service is offered to provide doctors
a convenient way to book more patients
on a consistent basis. Scheduling is done
as per the requirements of the office
which include working hours, total
providers, procedure type, locations, etc.
The actual appointments are scheduled
directly into the provider’s Practice
Management system. For patients that
are “no shows” or have missed their
appointments a reminder call can be
given on a routine basis to reschedule
their 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
DEFINITIONBACK-OFFICE TEAM

10. ELIGIBILITY VERIFICATION WITH
PAYERS
There are 3 methods for checking
eligibility:
1. Online
2. Automated Claims Follow-Up (IVR)
3. Insurance Company Representative
$6.5 per hour* onwards or
$2.20 per Benefit Verification based on
workflow plan.
REFERRAL SUBMISSION AND
TRACKING
For Specialists who requires a referral
or a pre-authorization form the
process starts with retrieving the
patient demographic information,
insurance coverage, procedures to be
authorized, and details of the provider
to which they will be referred. Once
the referral is submitted tracking will
be done to insure that the patient will
be authorized to see the specialist on
their designated appointment. This
service also allows for emergency
referrals on the date of service as
needed by the office.
$6.5 per hour* onwards
DEFINITIONBACK-OFFICE TEAM
It is the single most effective way of
preventing insurance claim denials. Our
service begins with retrieving a list of
scheduled appointments and verifying
insurance coverage for the patients.

11. PAYMENT POSTING
DEMOGRAPHICS AND CLAIM
ENTRY
DEFINITIONBACK-OFFICE TEAM
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 claim
submission, patients statements
submission, and denials tagging can
all happen at the time of payment
posting.
$6.5 per hour* onwards or $3.5
per $1000 posting based on
workflow plan
For Claim creation the process starts
with Demographic entry and insurance
verification. Either through scanning
documents to our billing team or having
it shipped in packages we collect all the
information necessary to generate an
encounter: demographics, insurance
information, and ICD/CPT codes.
Once the information is retrieved the
claim can be created using two
methods:
1. Manual Claim Entry
2. Auto generation
$6.5 per hour* onwards

12. CREDENTIALING
MEDICAL TRANSCRIPTION
SERVICES
DEFINITIONBACK-OFFICE TEAM
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 health
records (EHR) ensuring the highest level
of accuracy, privacy and security, to the
U.S. Healthcare service providers.
Transcription advantages:
1. Quality Assurance
2. Integration with HER
3. Consistency in Delivery &
Turnaround
4. Security & Confidentiality
5. Economy
6. Infrastructure & Resources
10 Cents per line

13. DEFINITIONCOMPONENTS
Hybrid Workflow Model™ consists of:
1. Back-Office Team
2. Technology Platform

14. DEFINITIONTECHNOLOGY 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.

15. DEFINITIONTECHNOLOGY PLATFORM
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

16. DEFINITIONTECHNOLOGY PLATFORM
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

17. DEFINITIONTECHNOLOGY PLATFORM
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

18. DEFINITIONTECHNOLOGY PLATFORM
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

19. 908-834-1608
info@clinicspectrum.com
Fb.com/Clinicspectrum
@Clinicspectrum.com
DEFINITIONFOR FUTHER INFORMATION