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International TPA Services

Cost Containment

  • Corporate Medical Network™

 

  • U.S. Cost Containment

 

  • Large Claim Review and Audit

 

  • Claims Management and Repricing

Our world-class health management solutions, including Cost Containment and Travel for Treatment are constantly evolving to ensure our international and domestic clients have a complete set of leading solutions to manage the three universal fundamentals of healthcare: Access, Quality and Cost.

Backed by strong systems and processes, highly experienced management and skilled staff, our health management solutions deliver important value to our clients and their insured members on a daily basis. 

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Corporate Medical Network™

 

Inside out January 2013  

 

A Worldwide Presence by Europ Assistance:

 

  • 10,000 acute care facilities
  • Over 600,000 physicians across 130 countries
  • Over 5,000 international facilities with cashless service

 

 

GCS continually works to enhance and expand our Corporate Medical Network™ (CMN™). New contracts are signed on a daily basis and the network includes industry leading hospitals, doctors, specialists, dentists and other medical providers in over 130 countries.

 

We know that members need more than just hospitals for their daily healthcare needs. The main contributing factor to any successful healthcare plan is to have access to a broad range of healthcare services and providers. Some international TPA’s and health management companies will boast about their hospital count when in reality a member will also seek services from a lab, pharmacy or general practitioner’s office, but we focus on all areas of the medical field when it comes to contracting. The CMN™ network covers a comprehensive range of healthcare specialties and fields including, but not limited to, specialized diagnostics testing, labs, neo-natal care, cardiac care, serious trauma injuries or burns, oncology, orthopedic, general to specialized surgery, organ transplants and occupational medicine.

 

Currently, we have a team of dedicated Provider Relations Network Specialists actively contracting with healthcare providers around the globe. In order to ensure we are consistently working with the best providers at the best price, we regularly review and evaluate our contractual relationships with all our providers while building relationships with the best providers in the region.

U.S. Cost Containment

 

Our long history of bringing people to the U.S. to access healthcare has allowed us to build an unparalleled direct contract provider network with industry leading discounts.

 

Combine our direct network, along with access to best-in-class HMO and PPO networks, and refined cost-based negotiations for a solution that will help reduce our client’s healthcare costs.

 

Our capabilities and performance in the U.S. market include:
 

  • Over $500 million worth of U.S. medical bills and over 300,000 claims processed every year
  • Highest net savings in the industry
  • Broad access
  • Best in class discounts with key  Centers of Excellence
Large Claim Review and Audit

Unique to the market, our large claim review and audits result in a signed agreement with the billing provider, ensuring that the settlement is never disputed.

 

Our large claim review and audit services provide clients with a full claims audit that includes line-by-line reviews of billed charges to identify and exclude any technical and coding accuracy errors. This results in claims charges being reduced before the application of the discount or reimbursement. In addition, this service can be applied to claims that are in or out-of-network.

 

Our review and audit services include:
 

  • Review of medical necessity
  • Unbundling of charges
  • Utilization review
  • Anesthesia services review
  • Supplies, materials and durable medical equipment (DME) review
  • Determining the room & board reimbursement rate
  • Comparison of charges against the hospital documentation
Claims Management and Repricing

Our medical claims experience covers all facets of the claims process and is backed by a system that allows for customized support and tracking of each client's specific processes and needs. Our detailed reporting and consultative analysis further enhances these partnerships.

 

We work with our clients to create a specific claims management process that works for their needs. Our commitment to managing our clients’ claims includes the following services:
 

  • EDI or customized file exchange
  • Complete TPA outsourced solution
  • Adjudication on our system or our clients system
  • Robust client portal