Do you need to ensure that you are paying fair market value on mid- to high-dollar Out-of-Network claims? If so, GEMDeal is the product for you.

How does it work?

One of our highly trained negotiators with an average of 10 years’ experience will examine the claim thoroughly. Any abnormality of either coding or clinical data is escalated to our GEMCode or GEM-MD services for further examination. Once the claim is validated, our negotiators benchmark the claim against comprehensive and objective criteria which include reported costs, usual and customary databases, Medicare rates, provider history, provider quality markers, etc.

Once the benchmark report is finalized, our negotiators call the provider to discuss a fair rate, an agreement is reached, a document signed, and you are sent a repricing report so that you can issue payment. If the provider is unwilling to negotiate we offer other options such as StrataGEM.

This service is available for any claim type (e.g., Hospital, ASC, Physician, Anesthesiology, Ambulance, Dialysis, Pathology, Implants, etc.).

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

We recommend that our clients consider an average turnaround time of 10 days so that we are not forced to compromise value for speed. If 10 days is too long, we invite you to consider our other products like QuickGEM or GEMLive. Also, since this service uses a number of expert resources, we require a minimum claim size of $5,000. If the claim is lower than that, we recommend that our clients consider QuickGEM.

Can I use GEMDeal as the specialized service overlay for higher dollar claims within my pipeline to supplement PPOs?

Yes. In fact, that is how many of our clients are set up, and the results show marked improvement over most services that see full claim benchmarking and negotiation as a last resort. Some of our clients want Global Excel to manage their supplemental PPOs for them, and so we combine GEMDeal with our QuickGEM repricing service. Irrespective of claim type or dollar threshold, Global Excel has solutions that can improve the cost-saving performance of any claim shop.

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

Our tools are the best in the industry – we use the best coding, clinical and financial benchmarks to profile the claim. This best-in-class information is managed by one of our highly experienced negotiators. Our negotiators average 10 years of experience – and that makes a difference that you will see in the results.

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