Medical Cost Containment & Claims Management
GMMI offers a full range of claims management, audit & negotiation services. Our team of experts is dedicated to provide the highest quality claims reviews.
GMMI’s claims service ranges from simple Network Claims Repricing, Out of Network Claim Negotiations, Best-Practice Bill Auditing, to the more sophisticated Coordination of Benefits & Subrogation services.
- Proprietary Networks (in the USA and globally)
- National Networks
- State & Region Specific Networks
- Carve-Out / Specialty Networks
- Reference-Based Pricing
- Out of Network /High Dollar Claim Negotiations
Discount Intelligence - with over 30+ years of medical claims management experience, GMMI combines the tools described above with our rules-driven medical claim administration software. When analyzing claims, GMMI utilizes its own claims data history as well as industry benchmarks, which include for example, reference-based pricing using Medicare + as the basis for claims negotiations and settlements.
Our negotiation services begin with a unique situational analysis to determine the best course of action for our clients’ claims. GMMI’s Negotiation services are optimal for:
GMMI's negotiations strategy eliminates the risk of deferred liability – negotiation settlements end with a signed-off agreement.
Part of our complete cost containment strategy includes the detection, and prevention of, Fraud Waste and Abuse through:
- Data Analytics through UCR/Medicare Benchmarking
- Claims Auditing
- OFAC screening
- Payment integrity through analytics for coding validation, unbundling and Corrective Coding Initiative Edits
