Medical Cost Containment & Claims Management

GMMI offers our clients access to networks with preferred pricing strategy.  Medical dollars are maximized when clients access:

• 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 26 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:

• Out-of-Network Claims
• Low-Discount Facility
• Global Settlements
• Unpaid or Dated Claims

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

24/7/365 Worldwide Assistance 

Our assistance services support leisure and business travelers, expats, volunteers or students with expert help whenever and wherever they may be. Our talented staff is as diverse as the clients who we represent. We are from every corner of the globe. With the diversity of over 25 languages in-house, assistance services are often delivered in the customer’s native language by our own staff. The most compassionate, caring, dedicated, and innovative team members interface with our clients’ patients and travelers alike. We embrace new technology, strive to deliver innovation in our services, and celebrate out-of-the box thinking to solve the simplest to the most complex [medical, travel, assistance, security] problems.
 

We are dedicated to a high standard of care at every level of the service spectrum, filled with empathy and professionalism to ensure the satisfactory delivery of a complete suite of services that include:    

• Medical Referrals
• Eligibility Verification & Submission of Verification of Benefits (VOB) to providers
• Reserve Setting / Cost Estimates
• Medical Case Management
• Medical Reports
• Policy Administration Support
• Travel Related Services, such as hotel and flight arrangements
• Ground Ambulance Services
• Medical Escort Services
• Air Evacuations
• Repatriation of Mortal Remains
• Facilitation of Financial & Legal Services
• Lost Luggage
• Lost Passport

To see the complete suite of Travel Assistance services, click here. 

Best-in-Class Medical Provider Networks 

Evidence-Based Medical Case Management & Utilization Review

Having a solid Case Management Program affords our case managers the tools to provide guidance and oversight to ensure the safest and most effective care to their patients. Our Case Managers' work influence care in ways such as transitioning care to other institutions or to the patient's home, management of the patient in the community, prevention of recidivism or unplanned return to an acute care setting, and anticipation of and planning for repatriation to home country. 

How does our Evidence-Based Case Management tie into our medical claims administration and ultimately benefit our clients?

1. The systematic use of published medical criteria supports GMMI’s  medical team with clinical indications for admissions and/or procedures. This secures that the entire medical is using the same criteria to give consistent approvals (approvals made based on client specific policy guidelines & coverage restrictions).  

2. Goal Length of Stay is outlined in the criteria which are crucial for decision-making support in determining a reasonable length of stay for in-patient procedures and medical conditions.

3. Benchmarks and Data Management tools are outlined and it provides GMMI with statistical bench marking to help measure and track variations in length of stay and readmission rates.

4. Effective use of the Case Management criteria strengthens the claims adjudication process. Approved Length of Stay and approved procedures are tied back to the claims adjudication process. Services billed in excess of the approvals are reviewed and challenged. 

By adhering to the medical criteria, GMMI delivers on the promise to clients of providing complete cost containment solutions. EBCM is a valuable tool that supports our mission to carry patients from sickness to health, distress to relief - anytime, anywhere.

International TPA

Expertise - power of our name - Global Medical Management - embodies the depth and reach of our services. GMMI offers the most reliable cost containment strategies for our clients – in the USA and globally. As a leading international TPA and health management company, GMMI helps employers address the challenge of ensuring their employees receive a level of healthcare coverage comparable to home country.

Experience- GMMI is poised to support our clients on a global scale. From proprietary to vendor networks to our cost containment, administration and specialty services, our innovative approach to the industry has global reach.

Our international TPA services include:

• International Proprietary Network
• Direct Billing for Inpatient and Outpatient care
• International bill review & claims adjudication
• Preferred pricing with high frequency network providers
• International Provider Vetting

Higher-level service can include:

• International bill translation and bill codification to meet U.S. billing standards (ie. ICD 10 coding)
• Provider Payments issued in local currency
• Member Reimbursements
• Medical Case Management & Utilization Review

Excellence – our network grows as our client business grows. A provider nomination process is in place that supports the expansion and variety of network providers. To learn how GMMI can support you with global benefits administration, contact us: marketing@gmmi.com

Technologies

Scalability

At GMMI, Inc. we have architected and implemented IT infrastructure technologies with long-term growth in mind. This allows us to rapidly scale and address our customer’s needs.

Security

Our ISO/IEC 27001:2013 Information Security Certification is the guarantee of security. At GMMI we use locked-down systems accessed via thin clients with no data stored locally. All access is logged and controlled via centralized authentication platforms. We believe in a layered approach to security and abide by industry standards and regulatory needs (HIPAA/GDPR).

Continuity

Business continuity is a priority at GMMI. Our data is hosted in hardened data centers used by local governments for emergency response systems.Production data is encrypted and replicated to geo-redundant facilities to ensure availability and access. Our geo-redundant intelligent phone system interface ensures that our Clients and their Members can get to us no matter what the circumstance is.  

Innovation

GMMI is committed to delivering and offering a wide array of digital solutions that will assist your Members & provide you with the tools you need. Mi.card, our Interactive Contact Card solution or Mi.GMMI, our next generation of Reporting Portal are some of the digital tools we can offer.