Seamless Prior Authorization,
Care Coordination &
Patient Engagement
for Surgery and Cancer Care
Surgeons & Anesthesiologists

Focus on surgery and clinical care. Cut the bureaucracy and take control of your financial future.

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Challenges
  • Prior authorizations are time consuming for your staff to complete.
  • Claims are rejected because of insufficient proof of medical necessity.
  • Transferring information to the facility where you are operating, whether it’s at a hospital or an ASC.
  • Patients are asked the same questions over and over again creating a negative experience.
Solutions
  • Digital prior authorizations with all the health plans you accept.
  • Digital generation of medical necessity proof.
  • Digital surgical consents.
  • Integration between your office EHR and the facility EHR.
  • Automated and digital H&Ps.
  • Digital surgery booking.
Achieve
  • Maintain independence by keeping the EHR of your choice while also streamlining the transfer of information from your office to the facility where you are operating.
  • Save hours on repetitive administrative tasks such as H&P dictations.
  • Track outcomes (patient reported and clinical) to increase attractiveness to health plans establishing narrow networks.
Ambulatory Surgery Centers

Operate at the scale of a larger system on the budget of an ASC. Integrate with your surgeons’ office EHRs. Speed up authorizations, achieve in-network status, and keep more profit through reduced claims processing costs.

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Challenges
  • Manual processes are labor intensive and expensive.
  • Competing against larger delivery systems can be a difficult.
  • Obtaining in-network status
  • Technology solutions are expensive and ineffective. There’s a reason why ~80% of ASCs are paper-based.
  • High degree of variation between surgery centers in a network run by an ASC management company.
Solutions

We integrate with the office EHR systems of all the surgeons who operate at the ASC and we deploy a light-weight solution at the ASC to absorb the data that comes over.

We use those integrations to:

  • Automate prior authorizations
  • Verify eligibility
  • Identify patients who are good candidates for surgery at the ASC
  • Send medical history summaries to the anesthesiology group to evaluate patients
  • Create digital H&Ps
  • Manage surgical consents
  • Generate H&Ps based on the surgeon office EHR
  • Book surgeries digitally
  • Track pre-op tasks and consults
  • Send out customized patient communication messages through multiple channels of communication from pre-op through post-discharge.
  • Collect patient reported outcomes
Achieve
  • Manage a network of ASCs with one standard solution to drive predictability, standardization, and operational agility.
  • Faster prior authorizations
  • Reduced claims rejections
  • Reduced accounts receivable (AR) days
  • Reduced claims processing costs
  • Engaged patients and their family members
  • Higher surgical volume through in-network status with health plans
  • Proof of high-quality care through outcomes analyses.
Hospitals & Delivery Systems

Achieve high margin surgical service lines and take on risk contracts with confidence.

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Challenges
  • Increasing profit margins seems out of reach.
  • Taking on value-based payments appears risky.
  • Managing prior authorizations and managing claims is slow and laborious.
  • Retaining surgeons is a constant struggle.
  • Technology is expensive and ROI is low.
  • Adding new centers and practices involves significant effort and expense.
  • Patient portals and educational initiatives have limited effect.
  • Change and adaptation is slower than desired.
Solutions

We start with integrating with surgeon office EHRs, the EHR at the hospitals and the EHRs across the delivery system.

We use those integrations to:

  • Automate prior authorizations
  • Verify eligibility
  • Identify the patients at greatest risk for cancellation and readmission
  • Manage the pre-screening process
  • Send out customized patient communication messages through multiple channels of communication from pre-op through post-discharge.
  • Collect patient reported outcomes.
  • Manage surgical consents
  • Generate H&Ps based on the surgeon office EHR
  • Book surgeries digitally
  • Track pre-op tasks and consults
Achieve
  • High profit margin surgical service lines
  • Faster insurance prior authorizations
  • Reduced claims rejections
  • Reduced cancellations
  • Reduced readmissions
  • Improved patient experience
  • Retain surgeons
  • Strengthen connections with primary care physicians
  • Engage patients and their designated family members (or friends)
Health Plans

Optimize the site of surgical care, digitize medical policies to enable more rigorous and automated prior authorizations, and provide financial transparency for patients in care decisions.

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Challenges
  • Ineffective prior authorization solutions with little clinical rigor.
  • Labor intensive and administratively expensive prior authorization process involving paper and fax.
  • Unstructured medical policies that are expensive to develop, difficult to update, adjust, and evaluate.
  • Lack of financial transparency for plan members.
Solutions
  • Digitizing medical policies.
  • Mapping digital medical policies to prior authorization forms.
  • Providing digital solutions for surgeon offices and facilities to electronically submit prior authorizations.
  • Managing surgeon referrals, in particular in collaboration with primary care network on global budget arrangements.
  • Patient-facing solutions to create cost transparency.
Achieve
  • Streamline payer and provider interactions (e.g., prior authorizations) to drive administrative simplification and to improve the member experience while maintaining the “sentinel effect”.
  • Significantly expand the use of more cost-effective sites of care supported by robust analyses of medical necessity and outcomes that can power surgeon referrals and the prior authorizations.
  • Utilize best in class medical policies that yield better outcomes at a lower cost.
  • Enable the modeling and analysis of potential medical policy changes.
  • Support value/risk-based contracts and global budget collaborations through referral management and site of care optimization.
  • Improve the member experience by providing greater orientation/engagement and financial transparency to prevent surprise bills across the surgical episode of care and information that may influence treatment location decisions.
Solutions

We integrate with any EHR system. Epic, Cerner, Athenahealth, name it, we can integrate with it. We then deploy solutions which utilize data from one or more EHR systems to drive financial performance, whether you’re a hospital, surgery center, surgeon group, or integrated delivery system.

Prior Authorization
Solutions utilize the compiled and structured episode of care data to automate interactions with health plans such as prior authorizations and proof of medical necessity for revenue cycle management.
Clinical Coordination
Solutions utilize the compiled and structured episode of care data to enable the hand-off of key information in the right form at the right time, with embedded capabilities to complete key clinical care tasks that are critical for patient care (e.g., screening patients for medical readiness for surgery).
Patient Engagement
Solutions utilize the compiled and structured episode of care data to create patient communications, educational messages, and financial transparency solutions that are distributed through channels of communication readily accessible to all patients.
The Power to Connect
Tailored solutions delivering the right information, in the right form,
at the right time, every time.
Applying our Solutions to a Surgical Episode of Care
01
Integrate with Healthcare Delivery Systems

We integrate with EHRs at surgeon offices, primary care clinics, hospitals and surgery centers to digitize mission critical workflows.

02
Integrate with Health Plan Systems

We digitize medical policy documents to create intelligent approaches to prior authorizations and evaluating submitted claims.

03
Manage Referrals

Manage referrals from primary care to high value surgeons and facilities.

04
Enhance Pre-op Evaluation & Management

Manage all pre-op coordination, consults, to minimize cancellations and readmissions.

05
Digitize Prior Auth

Manage prior authorizations with digital medical policies and submissions.

06
Optimize the Site of Care
Drive volume to the site of care with the best outcomes and the most cost-efficient delivery model.
07
Measures & Analyze Outcomes

Measure pre and post surgery clinical and patient reported outcomes.

08
Engage Patients

Patient communications and engagement through channels of communication already used by patients. Loop in designated family members.

09
Enhance Claims Submissions

We reduce your accounts receivable days and claims rejections by automating the summary of medical necessity from surgeon, hospital and ASC systems.

We Have Delivered for Our Clients, Let Us Deliver For You

We walk through walls to deliver for our clients. We pride ourselves on our responsiveness, delivery speed, and solving some of the most vexing and complex healthcare challenges. Here’s what some of them are saying about our solutions.

For surgeons every minute counts. We've been at the mercy of poorly designed and expensive software, and broken processes for years. As a surgeon, Medical Director of a hospital joint replacement program and the Medical Director of an ASC, I view ClinicalBox as critical to maximizing my time, our outcomes and financial performance, spanning clinical coordination, insurance coordination and patient engagement. Their most recent work on digital prior authorizations and summarizing the proof of medical necessity and the exhaustion of conservative measures prior to surgery, speeds up our authorizations, and reduces the rejection of claims.
Surgeon, Hospital Joint Replacement Medical Director, ASC Medical Director
ClinicalBox has worked with our sugery practice to streamline clinical coordination for hand-offs to the hospital and the surgery center (e.g., consents and H&Ps), and to speed up our insurance approvals. They are very attentive to the needs of the surgeon's staff who are instrumental in making things work behind the scenes. We are working with ClinicalBox to roll-out a digital prior auth process, which will save us a ton of time, allowing us to track where it is in the process, and automatically identifying the clinical notes that are most relevant. Their software is intuitive and training for new staff takes as little as 20 minutes.
Surgeon Office Clinical and Insurance Coordinator
ClinicalBox has significantly enhanced how we manage surgical episodes of care. ClinicalBox's software analyzes clinical data, notes, and labs to identify the riskiest patients. Patient safety is achieved by medical optimization. Also by robust, objective and reproducible risk stratification. Cancellations are reduced by care coordination. Costs are controlled by workflow integration. Shorter recovery times and early discharge are made possible by easier implementation of protocols. Pre-op patient-education and post-discharge follow up by a versatile patient engagement program goes a long way in giving our patients the ultimate patient experience. With ClinicalBox we feel better prepared for a future of value-based and bundled payment arrangements.”
Chief of Anesthesiology, Hospital & Integrated Delivery System
Our ASC has two main challenges: increasing surgery insurance approvals and decreasing claims rejections. ClinicalBox's approach to both is thorough and systematic. They have delivered from day one. Our work with them is aimed at increasing the volume of procedures we do and the contribution margin that each surgery generates. Instead of piecing together multiple different systems, they do it all through one economical bundle of capabilities.
ASC Business Administrator
ClinicalBox's software is the bridge between clinical care and insurance. Their comprehensive approach enables their customers to improve their strategic position, increase financial performance and prepare for where the industry is headed with value-based contracts and . I have rarely seen surgeons glow about any technology solutions but in our case it was the surgeons who advocated to the hospital administrators to move forward with ClinicalBox.
Hospital and Integrated Delivery System Chief Operating Officer
ClinicalBox is a mission critical platform for at our multiple hospital and surgery center campuses. They have have integrated seamlessly with our hospital's EHR system, enhancing the ROI of existing investments. Our nurses, surgeons, anesthesiologists, and administrative managers, all rave about the work that ClinicalBox does. Their analytical and reporting capabilities gives us unique insights into where we can improve care. Their most recent work focused on insurance coordination with prior authorizations, holds great promise. We are looking to engage in more risk-based contracting in the years ahead. A strong technology backbone is critical to taking that step with confidence.
Chief Nurse Executive, VP Patient Experience, Co-Chair of PFAC
ClinicalBox looks at service lines holistically, from pre-op through post-discharge. Their work helps us retain surgeons and have happy patients that make positive references in the community. We are confident that due to the enhancement of patient engagement and increased surgeon satisfaction, we are positioned for future success in the changing reimbursement landscape of risk-based contracts. The ClinicalBox team is very responsive to our needs and quick to adapt to our care redesigns with technology that supports standardization and evidenced-based practice implementations.Their use of outcomes measurement and analyses (patient reported and clinical), help us to continuously improve our service lines, by creating a feedback loop.
Director of Orthopedic and Bariatric Service Lines
The health insurance industry is replete with legacy approaches and processes that prevent the shift to both value-based contracting and cost/quality optimization of sites of care. ClinicalBox's approach to referral management, digitizing medical policies, electronic prior authorizations, and the proof of medical necessity for claims review, is unique and holds great promise as they expand their work across the country.
Insurance Industry Executive
Our surgeon office EHR and the hospital system EHR were cost-prohibitive to integrate and even cost aside we were skeptical whether either EHR system could deliver the solution we needed to coordinate care and to engage patients. ClinicalBox came in and was able to roll-out a highly effective solution at a fraction of the cost and the time. When I have needed reports generated for the hospital administration, ClinicalBox has delivered.
Surgeon Practice Manager
ClinicalBox is highly responsive to our needs. Patients receive customized communications and education, keeping them oriented at every stage of their care pre-op and post-discharge. This frees up the time of our nurses to do work that only they can do. They also provide top notch analytical capabilities. We needed a report generated on a prescreening quality improvement intiative, and they were able to quickly generate a report on the value of that intervention. It was easy because they are collecting valuable data in the background, so when it becomes needed, it doesn't mean a ton of work to get a clear answer.
Clinical Nurse Manager, PACU, Endo, Hospital Surgery Department, Pre-screening
I am responsible for the health of the population of patients who are undergoing surgery at our hospital. ClinicalBox enables the flow of information from the surgeon’s offices and across our delivery network to the hospital, which are all on different EHR systems. This creates greater transparency throughout the care continuum, allowing our staff and nursing teams to proactively resolve challenges when they arise. ClinicalBox’s solutions free up our nurses and care teams to more purposefully use their time for patient care and clinical decision-making.
Nurse Liaison for Hospital Campus Surgical Services
Our prescreening no-show rate has gone down and our patients show up prepared for their visit. We see the very sickest patients who are having surgery and there are many challenges in managing their care. We're the last line of defense in making sure that the patient is prepared for surgery. ClinicalBox helps us to fulfil that mission.
Surgery Prescreening Coordinator
Meet Our Team
We know healthcare and what it takes to transform the industry.
Request a Consultation

If you would like to learn more about how ClinicalBox can work with you to optimize care and maximize your capture of value, please let us know.

We will set-up a consultation to discuss how we can work together to prepare your organization for the future of healthcare.

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