News and Events

GTESS Adds Duplicate Claims Detection to its CleanClaim Technologies™ Service Suite

May 4, 2004 (Richardson, TX) 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. This capability, 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 to offer a duplicate claim detection capability which is applied to claims prior to the adjudication process. Historically, payers have used duplicate claim detection software applications post-adjudication, after costly duplicate payments have already been made. This drives up the cost of processing and results in recovery processes that are lengthy and expensive, adding to the claim-payment frustration of members, employees and providers.

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"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, GTESS VP of Sales & Account Management. "In addition, our duplicate claims detection is significantly more comprehensive than that available in other claims systems."

"Our 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," continued McGahey.

"Duplicate claims are a costly administrative problem in the healthcare industry," said GTESS CEO and President Deborah M. Gage. "Duplicate claims processing costs are estimated at $8 - $11 per claim, and apply to 7-10% of total claim volume. Even more costly is the labor cost related to the manual review of up to 25% of all claims received because they fall into the category of ‘possible’ duplicate claims. 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."

"Our proprietary database of claims representing health plans and benefit administrators from across the nation provides unique insights into the detection of duplicate claims within the pre-adjudication process," said GTESS VP of Research & Development, Vincent Borodziewicz, Ph.D. "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."

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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), claim edits and verification, membership and provider validation, repricing facilitation, claim routing and tracking, document management, and 'clean-claim' EDI delivery.

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Karen Hallman
GTESS
972.792.5500

Ellen Donahue-Dalton
Dalton Associates
404.442.7900