Did you know that you can negotiate excellent rates while the case is active? Yes you can – and these deals are often much better than back-end deals. In short, during live case negotiations the plan is still treated like a valued purchaser, versus back-end negotiation where the plan is treated like a money tree. GEMLive is our core product and we have been it using successfully for 15 years.

How does it work?

Once a case is identified, and case management begins their work, we are advised to start negotiating a rate for the services, and we estimate the potential financial impact of the claim.

We discuss the case with the provider to secure a fair reimbursement schedule while working with your case management team to ensure proper transfer of relevant information. Once an agreement is reached, a document is signed and we record that agreement in both our systems so that we can reconcile payment when the claim is received.

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

It is technically the “fastest way to get savings”, as the deal is secured before the claim even exists. This is the best way to get quality savings with speed and administrative ease. As for thresholds, GEMLive is designed to impact cases that are projected to cost $50,000 or more – and we can even help you estimate the potential cost of treatment at the outset.

How is your approach to Live Case Negotiating any different from other vendors?

There are not many vendors that offer this service. We have seen some Case Management entities work in this space, but the results suggest that this is not a core service or that they lack the dedicated expertise needed to really impact the claims. At Global Excel, claims negotiation is what we do.

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