Answers to Your Questions
Donna Taylor
Executive Vice President and
Chief Operating Officer
Q. What makes your platform unique?
A. Using adaptable optical character-recognition technology, our platform applies logic – in an automated fashion – that would normally fall to a human to apply, enabling our clients to achieve enhanced quality, better turnaround times and significant cost savings.
Q. Why should I choose GTESS instead of outsourcing offshore?
A. Our automated solutions replace error-prone offshore labor solutions. This translates to significantly less claims to review by operators, increased claim quality, and the elimination of potential and economic risks of offshore models. Plus, you gain a U.S.-based team that is available when you need assistance in identifying business needs or support during implementation and beyond.
Q. There are many phases in the Claim Lifecycle. Where do GTESS solutions fall?
A. We think about the Claim Lifecycle in six phases: claim management, provider management, clearinghouse, pre-adjudication, repricing and adjudication. GTESS specializes in helping our clients automate the pre-adjudication and repricing phases, making the actual adjudication process more efficient. Because we take a consultative approach and customize our solutions, we strongly impact our client's ability to process claims quickly and accurately.
Q. Is reducing the cost of transactions your primary focus?
A. Reducing transaction cost is one of the most important benefits that we provide to our customers; however we are focused on much more. We place a high priority on improving our clients' overall adjudication process with our ClaimPRECISETM platform. It is our goal to improve our clients overall claims processing from claim receipt to final determination.
Q. I understand you serve benefit administrators, networks and health plans. Do you support Dental Plans, in particular?
A. Yes, three of our largest clients are Dental plans. We have more than a decade of experience processing dental claims; a Dental form library with more than 300 registered dental forms and the ability to register specialized dental forms; robust Dental Rules and Edits that run against membership, market area, services and specific dentists or practices; and provider & member matching technologies with a 99% matching guarantee to improve first-pass rates.
Q. Do you also serve the Medicaid / Medicare market?
A.Yes, our automated solutions focus on government administrators and plans' unique processing requirements, delivering superior claim quality, lower costs and guaranteed compliance without additional capital investment or human labor associated with traditional solutions. Implementation and deployment of new business rules are quick, and solutions are automatically updated and deployed when new regulations are promulgated. Our solution includes complete extensive data field cross-walks, supports dual usage provider identifiers, processes both standard professional, institutional and dental as well as unique state government required forms.
Q. How does GTESS ensure customers remain regulatory compliant?
A. Our team stays on top of healthcare and industry policies and regulations and makes necessary platform changes to ensure our clients remain compliant without additional costs, installation headaches or delays.
Q. How does your solution ensure HIPAA compliance?
A. Our technology has a tamper-proof ability to slice personal information from other information on a claim, ensuring HIPAA compliance is always maintained. Many other competitors do not have this ability – they essentially 'hide' personal information, which, of course, could then be found.