Specialty-focused RCM for Orthopedics, Pain Management, Anesthesia, Comprehensive Therapy & also Multispecialties, with human-guided automation that reduces denials, accelerates cash flow, and never leaves compliance to chance.
STRATEGIC VISION
RESOURCE STRATEGY
AUTONOMOUS WORKLOAD
HUMAN-IN-THE-LOOP JUDGEMENT
PATIENT PIPELINE
The client moves flawlessly through an 8-stage sequence they direct entirely from their
personal browser, keeping practice staff out of the paperwork loop.
01
Open Practice Portal
02
Profile Registration
03
Coverage Check
04
Schedule Booking
05
EMR Sync Commit
06
Provider Care Prep
07
Visit Scribing
08
Closed RCM Loop
INTELLIGENT INTAKE
DOCUMENT UPLOAD HUB
Driver's License
Insurance Card
LIVE DEMOGRAPHIC RECORD
RUNTIME: 0.14S
First Name
Last Name
INS_ELG_S1_CALIBRATION
Insurance Name
Verifying with Payor…
Verifying with Payor…
Verified & Your Insurance coverage is active
ELIGIBILITY CHECK
Once a patient is registered, Clientele Pulse verifies insurance eligibility in real time through a secure clearinghouse, delivering results in less than 30 seconds.
PULSE NETWORK API INTERROGATION
Automated Real-Time 270/271 Portals Query
Instead of Calling Insurance or spending hours checking portals, the Pulse maps out the coverage, Copay, Co-insurance, Deductible/met and PCP name instantly.
Payer: Connect-pro
|
Active Status
|
Active |
|
Last Name, First Name,
Middle Name |
(Awaiting synch...) |
|
Copay
|
$20 |
|
Co-Insurance
|
20% |
|
Deductible / Met
|
$5000 / $3500 |
|
PCP Name
|
Dr. John Anthony |
SYNCED CALENDARS
Front search eligibility fields straight into calendar synchronization with zero office phone calls or receptionist manual checkups.
SELECT PHYSICIAN
Dr. Park – Internal Medicine
OFFICE LOCATION
Westview Medical Clinic
VISIT REASON / SPECIALITY
Annual Physical Procedure
Book an Appointment
SYNC & COORDINATION
Zero-Option Integration
STATUS REPORT
Waiting slot confirmation…
UNIFIED MESSAGES
SELECT ROUTING CHANNEL
FD - Front Desk Routing
General check-in, schedule changes, office hours.
CR - Provider Clinical Routing
Rx refills, lab results, specialist referrals.
RCM - Practice Billing Routing
Invoices, payment plans, insurance questions.
FRONT DESK INTERFACE
TLS Security: Enabled
10:45 AM - PATIENT
Can I change my physical procedure on Thursday to late
afternoon? My team meeting moved!
11:02 AM - DESK (AUTO)
Understand Anna, we found matching open slots with Dr. Park on Thursday at 3:30 PM & 5:00 PM. Swap completed?
Automated booking logic helps redirect directly to the patient’s EMR File.
CLINICIAN SUPPORT
By structuring complex client narratives before, during, and after visits, clinical teams focus on direct diagnostic care rather than documentation hurdles.
PHASE 1 - PRE-VISIT MISSION
Comprehensive Aggregation
Patient information is intelligently consolidated into a single unified view, including previous visit history, intake records, insurance eligibility verification, prior authorization requirements, authorization workflows, and diagnostic/lab reports; enabling providers to access complete patient insights in one screen.
✓ Exhausted & Sorted File
PHASE 2 - MID-VISIT ROOM
Hands Off Keyboard
Ambient room audio intelligently captures and analyzes patient–physician conversations, transforming dialogue into structured medical chart notes in real time. The system assists providers by generating medical necessity documentation, recommending relevant ICD-10 codes, CPT codes, and estimating the average billed amount for the visit
✓ Ambient Voice Scribing Active
PHASE 3 - POST-VISIT RCM
Closing Billing Payloads
Clinical documentation is reviewed through a human-in-the-loop quality process, enabling continuous AI learning and improving provider accuracy. Progress notes are validated and mapped directly to billing recommendations, ICD-10 codes, CPT codes, modifiers, and ICD linkage checklists to reduce downstream claim denials and improve reimbursement accuracy.
✓ Sync Manual Logging Log
AUTOMATED BILLING
The artificial intelligence automates prior authorization files and validates modifiers upstream to safeguard collections from payer denial traps.
PA
Prior Auth (PA) Orchestrator
Queries diagnostic medical necessity rules and builds out documentation packets, automatically posting data directly to insurers.
● Autonomia criteria gathering.
● Zero hours spent on phone tag.
AD
Autonomous Diagnostic Coding
AI models search channel narratives to suggest appropriate modifiers, ICD-10
groupings, and bundled procedure validations.
● Radiating Bundling Trim.
● Flags code exclusions prior to save.
DENIAL PREVENTION
OPERATIVE CLASS VALIDATOR 08
Missing CPT Modifier - 25 on Orthopedic Consultation
Subscriber Name Mismatch on Insurance Entry
Invalid Bundling Protocol (99214 Evaluation / 20610 Injection)
*SELF HEALING ENGINE RESOLVES 94.2% OF COMMON BUSINESS CODING
MISTAKES AUTOMATICALLY
FIDELITY SCANNING LOGS
Clean-Pass Submission
94.2% Clean
Payer Denial Lag Speed
-35% Less
Days Claims Outstanding
< 12 Days
Pulse’s cloud database routes submissions to clearing networks without manual human hands.
Automated Payment Posting
Clientele Pulse automatically posts payer payments, analyzes claim outcomes, and identifies underpayments, zero-payment claims, and unpaid claims. Exceptions are organized into prioritized worklists and assigned to dedicated human-in-the-loop teams for timely resolution, preventing AR buildup and improving revenue recovery.
*Maintains a continuous loop ensuring claims do not age past 60 days on accounts receivable registries.
Accounts Receivable Automation
Clientele Pulse continuously monitors claim status in real time through integrated payer networks and analyzes claim history from EMR/EHR data, payer policies, and specialty-specific billing guidelines to identify root causes of claim delays and denials.
The platform recommends the optimal resolution path, whether to submit a corrected claim or initiate an appeal with supporting documentation. It maps RARC and CARC codes, automates appeal workflows, and enables one-click claim resubmission to accelerate payment recovery.
SPECIALIZED PORTALS
Segmented layouts representing real-time synchronization loops for clinical, scheduling,
billing, and practice leadership teams.
Secure Access Mobile Companion
Patient: Anita Lopez • Standard Records Companion
Clientele Pulse provides patients with a secure mobile and web companion that gives them control over their healthcare journey. Patients can access verified demographic information, manage insurance details, review benefits, schedule visits, communicate with care teams, and stay connected with their treatment plans — anytime, anywhere.
Key Features:
Clinician Visit Assistant
Provider App – Clinician Visit Assistant
Clientele Pulse Clinician Visit Assistant empowers providers with a complete, real-time patient and revenue intelligence workspace. It delivers a 30-second pre-visit snapshot, clinical history, diagnostics, AI-powered documentation, coding guidance, and practice performance insights — helping clinicians focus on patient care while reducing administrative burden.
Key Features:
Clientele Pulse Bridge
Front Office Portal – Clientele Pulse Bridge
Clientele Pulse Bridge connects the front office workflow with the Patient App, Provider App, Payor Network, and EMR/EHR/PM systems to automate and streamline the complete patient journey — from registration through check-out. The platform enables front desk teams to deliver faster, smoother, and more accurate patient interactions through digital workflows, real-time verification, and integrated care coordination.
Key Features:
PLATFORM ALIGNMENT AUDIT
SERVICE STATUS: NOW
99.2% Clean
-25% Decrease
< 12 Days DSO
80% Saved
