GTESS to Provide New Strategic Outsourcing Services to Healthcare Industry, Duplicate Claims Detection added to existing business process outsourcing services

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GTESS Corporation, a leading provider of business process outsourcing services for the healthcare industry, today announced the addition of Duplicate Claims Detection to its front-end claim-processing service suite. GTESS offers strategic outsourcing services to managed care organizations and benefit administrators. The company’s claims management services enable the healthcare industry to gain quality and service improvements while focusing on strategic initiatives and positively impacting their bottom line.

GTESS Corporation, a leading provider of business process outsourcing services for the healthcare industry, today announced the addition of Duplicate Claims Detection to its front-end claim-processing service suite.

GTESS offers strategic outsourcing services to managed care organizations and benefit administrators. The company's claims management services enable the healthcare industry to gain quality and service improvements while focusing on strategic initiatives and positively impacting their bottom line.

Duplicate Claims Detection, available to GTESS clients in the fall of 2004, will offer healthcare payers the ability – in the pre-adjudication process – to identify duplicate claims before payment. GTESS is the first outsourcing provider to offer such a program.

"GTESS clients will be among the first to move this process up front -- before claims are paid -- offering considerable savings in both the total cost of claim payments and improving the service to members and providers," said John McGahey, VP of Sales & Account Management for GTESS.

Historically, payers used duplicate claim detection software applications post-adjudication. This is after costly duplicate payments have already been made. Duplicate Claims Detection will allow GTESS to offer higher quality and faster turnaround for claims management.

"Our Duplicate Claims Detection is significantly more comprehensive than that available in other claims systems," noted McGahey. "Clients reported duplicate claim detection as one of their top priorities at our 2003 Partners’ Forum, so this service suite expansion is in response to their requests."

Duplicate claims processing costs are estimated at $8-$11 per claim, and apply to 7-10% of total claim volume. Even more costly to the healthcare industry is the labor connected with the manual review of up to 25% of all claims received.

"Duplicate claims are a costly administrative problem in the healthcare industry,” observed President and CEO of GTESS, Deborah M. Gage.

"Identifying and managing these duplicates will allow our clients to reduce costs and improve the quality of service they offer to employers, members and providers."

VP of Research & Development, Vincent Borodziewicz, Ph.D. remarked that Duplicate Claims Detection allows GTESS to offer the best strategic outsourcing services to its clients.

"We have leveraged our deep healthcare expertise and statistical modeling capabilities to define the optimum logic for identifying duplicate claims, as well as predictive methods for determining the duplicate claims detection percentage based on the manual resources clients currently spend reviewing potential duplicate claims."

The claims management services at GTESS replace error-prone human processes with automation. The GTESS Virtual Front End Suite of services includes outsourcing claim receipts (paper and EDI claims), claim edits and verification, membership and provider validation, re-pricing facilitation, claim routing and tracking, document management, and 'clean-claim' EDI delivery.

About GTESS:

GTESS provides business process outsourcing services to managed care organizations and benefit administrators. The company leverages proprietary technology to provide pre-adjudication claims processing, replacing error-prone human processes with automation. The GTESS Virtual Front End suite of services includes outsourcing claim receipt (paper and EDI claims), duplicate claim detection, claim edits and verification, membership and provider validation, PPO Connect™ enhanced repricing facilitation, claim routing and tracking, document management, and 'clean-claim' EDI delivery. GTESS has a growing list of more than 20 trading partners, including most regional and national PPO and network providers. Click on business process outsourcing services from GTESS, for more information.

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Ellen Donahue-Dalton
GTESS
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