ClinicSpectrum’s In- House STAT Eligibility Verifications Solution

Eligibility Verification by Clinicspectrum

Although perpetual breakthroughs and continuous innovations in the field of medicine and technology offer people improved quality of life, the fact remains that the cost of medical care is on the rise.   For many, health coverage is a huge concern, as some have not renewed their plans or don’t have the adequate insurance for their medical needs.  The high monthly premiums have put off many people, but choosing not to enroll is an even more expensive decision.

Under the recovery act, the main contentions are:

  • Preventative care must be covered by insurance
  • A pre-existing condition does not mean the insurance will be denied, neither will it involve greater deductible

On the flipside:

  • Insurers can no longer place lifetime caps on the deductible to be paid
  • Americans without an insurance plan will have to get one, or pay a designated penalty

With some benefits as “no denials” or “extra deductible for conditions”, people are quite keen and eager to promote the act, despite its breakdowns.   Moreover, even with a high deductible, you still pay much less than you would while paying out of pocket medical expenses incurred by care.  ClinicSpectrum’s eligibility verifications solution is a prime choice for these circumstances. ClinicSpectrum’s STAT Eligibility Platform, a seamless eligibility verifications solution is vital to clinicians. Under the new health care act, the influx of eligibility for patients will increase manifold and tracking high deductibles in an efficient manner may prove difficult and downright taxing. ClinicSpectrum proposes to use the software based on eligibility criterions and patient records, through complete automation of the processes involved.  STAT Eligibility secure portal will replace traditional emails, phone, and other manual services, and will provide concrete, relevant benefits data within 45 minutes of turnaround time.  This is also going to mean a significant reduction in the manpower required for operations, through our electronic verifications system.  It additionally also uses a real time connection with insurance companies, websites, and clearing houses, all while the communications are delivered by the ClinicSpectrum back office team.

Operational Cost Reduction in a Changing Healthcare Environment

With cutting edge technology and daily medical breakthroughs our healthcare system appears to fit the mold of streamlined perfection, however the rising challenges of daily medical group operations are quietly overlooked without an obvious solution.

Doctors are challenged to divert their focus from treating patients, to tedious claim chases and endless denial follow ups, causing additional frustrations to the already perplexed lowered insurance reimbursements. Office managers are equally defied; faced with high turnovers, limited solutions and high operational costs, the days at the office just got longer. And it’s no wonder, as the cost of maintaining a profitable business the old fashioned way is not a sustainable option.

So what is the solution? Hybrid workflow! Imagine this: You walk into your office, log in to your computer and the first email you see depicts a picture perfect world, full of clarity and insight. Easy to understand spreadsheets with complete breakdowns of outstanding accounts receivables and valid reason explanations for easy claim correction and resubmission. Or better yet, a full report of your patients’ appointments confirmed in advance with detailed eligibility and benefits verification with authorization codes available prior to treatment. How about pages of scanned documents which are seamlessly indexed to their designated folder? It can happen! I know what you are thinking, this is too good to be true, a sci-fi flick with virtual reality inserts, no such solution exists in real life. Wrong!

Eligibility Verification

Unique back office solutions can significantly enrich your current workflow in the areas of Claims Entry, Payment Posting, Accounts Receivable Follow Up, Denials Management and Credentialing. The hybrid workflow model ensures resourceful manpower, extensive healthcare expertise, and warrants the tedious work of aggressive follow ups, amongst other services, to be completed, all while away from your office. A virtual office genie can do all your work and increase your bottom line by up to 20%, all while reducing operational cost by as much as 30%. In order to survive the changes in the healthcare environment, medical groups can outsource various billing modules to third party solutions to maintain profitability. Off-shore labor power allows lowered operational costs and increases profitability instantly, putting medical groups in a lucrative space yet again. Don’t let your frustrations slow you down, Eligibility Verification solutions are here to stay.