GEMCode is a code editing and support product that generates savings with minimal noise so that you can fulfill plan administration requirements. It has dedicated databases for both professional and facility editing – and actively cross-references 16 million data elements and the unique patient history for possible coding issues and abuses. GEMCode is a superior option for the discerning buyer.

How does it work?

GEMCode is designed to review any claim type: facility, professional, Out-of-Network and In-Network. Our system scrubs claims for coding and basic clinical edits to ensure they are compliant and ready for payment. The editing information and reductions are applied to the payment and an explanation is supplied. Providers can submit appeals (if applicable) to Global Excel for further review and settlement.

How long does it take and is there a minimum dollar threshold?

Once the claim is in our system, it is immediately scrubbed for edits. There is no threshold as we believe all claims should be edited for integrity, but in most situations we require a direct connection to support this service.

How is your approach to editing any different from other vendors?

For one, we defend our edits – we don’t just cut a line and walk away like many other vendors. Second, we have independent edits for professional claims and independent edits for facility claims. Some editing systems look to apply physician edits on facility claims, which often causes complaints, balance billing and exposure to liability for the plan.

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