Corporate Case Study
MyGEM starts with you.
We understand that TPAs, HMOs, first-dollar insurance carriers, self-administered plans, and medical excess carriers all have different needs. For this reason, we do not believe that a cookie-cutter approach works in the world of medical cost containment. At Global Excel, we offer customized products bundled to suit your unique cost containment needs and goals, allowing you to maximize the impact on your net savings. We supply support and training from start to finish, ensuring a quick and efficient implementation into any claim shop. Tell us your goals, and together let’s build a MyGEM for you.
How does it work?
If you look over our product descriptions, you will see that we have all of our bases covered to enhance the cost-saving performance of any claim shop.
- GEMDeal Out-of-Network negotiation
- GEMDeal-IN In-Network negotiation
- GEMLive Live case negotiation
- QuickGEM Lower-dollar or dollar-one repricing and negotiation
- GEM-MD Clinical reviews
- GEMCode Code editing
- StrataGEM Problematic claim negotiation
- GEMWatch Financial primary analysis
- GEMScope Claim performance evaluation and analytics
Through discussion and analysis, our Business Development and Account Management staff are able to work with you to propose customized solutions that are tailored to your unique needs.
In short, we value customization and offering a superior customer service experience so much that we branded it with MyGEM. This unique approach to customer service has secured us a client retention rate of more than 98%. In our experience what matters most to our clients and has the greatest impact on their satisfaction, is the way they are treated by the people they come into contact with everyday. We know that everyone in our organization has the power to affect your experience.
Once we map out your unique needs and customize MyGEM services to suit you, your account manager will be your dedicated internal representative at Global Excel and will ensure a seamless implementation, promptly addressing any questions or concerns. We are committed to making every project a success.
What are the results?
Kindly refer to our corporate profiles to see how GEM can improve your savings and process efficiency.
How do I start?
First, we connect you with our business development staff so that we can take the preliminary steps of understanding your unique needs. We normally recommend a claims performance analysis through our GEMScope product to determine our anticipated impact – if we can show value, peace of mind, and administrative ease of use, then we will work towards creating a MyGEM for you.
How much do MyGEM products and services cost?
Unless specifically stated in the individual product descriptions, all our rates are contingent upon our savings – no deal, no cost. The percentage of our fee is also dependent upon the volume that is forwarded to us. We may also consider our rate in light of other Global Excel products you utilize within the MyGEM suite. We are committed to long-term partnerships with our clients and we are confident that we can satisfy your pricing needs.
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Corporate Case Study
The Setup
In April 2009, Global Excel partnered with ‘Client A’, an 80 000 thousand life national TPA with a typical out of network exposure of 10%. Client A’s Out-of-Network solution was a logo’d supplemental network who also offered claim negotiations.
Pre GEM
Their previous year’s data on Out-of-Network claims over $10k showed the following success rate on $50.3 million in billed charges:
7% hit rate on value/dollars
3% gross savings.
On $50.3 million in billed charges, over $49.39 million was left without discount…
Enter GEM
At the time, Client A’s process was to have examiners manually review all claims over a set threshold.
In establishing MyGEM for this unique TPA, we identified the following products to maximize their results and also ensure a smooth transition from their previous vendor; GEMDeal, GEMDeal-In, QuickGEM and StrataGEM. A threshold was set for claims over $10K to be submitted to GEMDeal for negotiation. If negotiated settlements were not possible, other options were to access our suite of supplemental PPOs through QuickGEM or, where appropriate, our U+C product StrataGEM.
GEM in Action
Client A currently sends their claims by email but an EDI connection is underway to streamline our process and decrease turnaround times. Average bill size is $55k.
After the first 6 months of partnership, Client A’s Out-of-Network savings have increased tenfold:
74% hit rate – A 104% increase
32% gross savings – A 102% increase
So, on the $50.3 million that GEM didn’t get…
Client A paid just over $49.39 million on claims over $10K with previous vendor, obtaining savings of less than $1 million dollars.
Had GEM worked these claims, current figures show that the client could have saved up to $11.91 million dollars!
Conclusion
This is the story of how GEM changed the way this client experiences their Out-of-Network claims. In addition to an EDI connection, we are also currently in discussions to add our GEM-MD and GEMLive products to maximize impact on their net savings.
A smooth transition, great customer service, thoughtful partnering, and ultimately a massive impact on their bottom line have fostered the beginnings of a long lasting partnership.
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