Multiple Delivery Options Available

GTESS offers a number of delivery options to meet the unique needs of any client. The following outlines the core offerings that are often blended to meet clients' specific needs.

Outsource

Turning front-end claims processing over to GTESS.

With this option, our automated front-end services, which leverage GTESS' patent-pending software technologies, are delivered via GTESS SAS 70 operations in a technology secure environment. For the exception processing we use either onshore resources or offshore resources or a combination of the two depending on your business requirements. Benefits include cost savings without the risks of cost increases, quality fluctuations and security issues associated with manual input of the claim.

Benefits:

  • Guaranteed claims quality and operational turn-around times
  • No additional hardware to purchase or supporting infrastructure required
  • No annual maintenance fees or IT staff required for system maintenance
  • Rapid, flexible implementation schedules to meet deadline
  • Guaranteed level of support and system availability
  • Frequent product revisions and upgrades administered without service interruption

Insource

Using GTESS automated solutions.

With this option, your claims processing personnel conduct the exception-processing step in claim data cleansing and validation. This option is perfect for those clients who want to gain advantage of cost, quality and security benefits of GTESS automated solutions while using internal personnel for part of the process. Clients do not need to invest in large-scale computer hardware, software or operate a data center with this option. With minimal hardware investment, you can power virtually any number of exception processing personnel as all automated claim data enhancement is done in GTESS secure data centers, which are SAS 70 Type II compliant. While most clients who choose this option use their own personnel to perform exception processing, others opt to use a combination of their own staff and GTESS resources.

Benefits:

  • Gain the benefits of ClaimPRECISETM when a complete BPO solution is not right for you
  • Retain data cleansing and validation functions within your organization without data center costs
  • Leverage Cloud Computing with HIPAA compliance

Claim Redaction

An optional delivery feature for GTESS solutions.

Today, there is increasing concern about the protection of PHI (protected health information) as well as PII (personally identifiable information) on health claims. No matter the delivery option you chose, GTESS' Claim Redaction is a process that removes all PII from the digital claim file and claim image prior to its dispatch for processing.

Redaction uses GTESS' form definition technology to "slice" through each claim image and physically separate the PII section from the rest of the claim. Each image fragment can be independently routed to data correction and investigation teams in separate locations. With Redaction, pixel values in the non-PII claim image are obliterated, removing PHI and eliminating security risks.

Benefits:

  • Attractive price advantages and quality guarantees that come from processing the non-PII sections of the claim with less costly offshore labor
  • Assurance that PHI is eliminated for claims during human-based Exception Processing activities
  • Guarantee that critical PII information does not leave the U.S. and is processed at GTESS-owned onshore or Client-owned processing locations
  • Ensures HIPAA compliance