20 years in the industry has taught us that being a well-oiled machine is just not good enough… With different scenarios arising on a daily basis you need to be prepared; that is why our staff is trained to focus on every aspect of the business appropriately, from reviewing claims to confirming eligibility, every situation gets its own consideration, research and review.

Claims Administration Services Include:

  • Claims Processing- combining our state of the art software with experienced processors, claims are adjudicated accurately and efficiently.
  • Medical and Claims Review- Claims that are flagged or look suspicious go out for a special audit, stopping claims from being paid freely.
  • Medical Management- When illness strikes the number one goal for the individual and the family is to get healthy. Medical management allows the members to get guidance on what providers they should use, what their benefits allow and the best way to utilize what is offered to them.
  • Flexible Claims Reports- In order to save on health plans, you need to understand and follow the usage pattern of your members. With our flexible reporting you can see detailed utilization by types of service, costs of service, dependent usage and more.
  • High Dollar Claim Alerts- Besides for spot checking claims and setting up alerts for repeated services and potential fraud, any claim billed over $10k gets manually reviewed thoroughly and meticulously to ensure the right codes are being used and the correct payment is being made.
  • Stop Loss reporting- working closely with a stop loss carrier is imperative in the self-funded world. We keep a tight relationship with our carriers and are in constant contact with them with reports, notifications and other relevant information.

Plan Administration:

  • Manage Eligibility- We accept eligibility in EDI format through an 834 or on an Excel spreadsheet. Usually, new hires and terminations are updated within 48 hours of receipt and a package goes out promptly.
  • COBRA Management- All employers that have 50 employees or more are required to offer COBRA coverage to their employees once they are terminated or ineligible for coverage. GMR offers to take care of that obligation by sending out the appropriate notices and collecting the funds directly from the employee so that the employer need not get involved and rather focus on running their company.
  • Cost Containment Strategies- Everything we do is focused on saving you money. We have many strategies and techniques to keep costs low on RX claims, professional claims and institutional claims.
  • Dental, Vision and Wellness Programs- There are hundreds of firms out there that offer dental networks, vision plans and wellness programs. We do the research for you and partner with the companies that have the most to offer; allowing your employees to benefit from our partnerships.
  • RX Coverage With a robust pharmacy network, members are bound to find a participating pharmacy around the corner! We offer specialty drugs at lower costs and mail in services so that members can save money on co-pays

Wage Parity

The Wage Parity Act was passed in 2014. It states that any home health aide that gets reimbursed through Medicaid must get a minimum of $10.00 per hour of base pay and $4.09 per hour in either wages, employee benefits or a combination of the two. GMR issues Minmal coverage to Home Care agencies so that they can fulfill the Wage Parity Act in an efficient way. We do all the calculating and benefit tracking so you don’t have to.

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Customer Care:

  • Knowledgeable and Patient Representatives- Our number one priority is customer care. We work closely with your employees to ensure satisfaction. After all, happy employees make happy employers
  • Member Portal for Real Time Information- losing a medical ID card is not a reason to avoid going to the doctor or getting prescriptions filled. Employees can log onto our portal and get their insurance information to go to providers and get their medications. They can also request a new card to be sent to them online, not needing to interrupt their day to call.
  • Variety of Networks- We offer multiple networks and guide you based on your location and the potential savings with a specific network. In addition, we have partnered up with negotiation teams and claim edit review teams to minimize your cost.