News and Events

GTESS Announces Expanded Repricing Capabilities through PPO Connect™

June 9, 2004 (Richardson, TX) GTESS Corporation, a leading provider of business process outsourcing services for the healthcare industry, today announced upgraded and enhanced repricing capabilities. PPO Connect™ features multiple-point and multiple-network connectivity to all national and most major regional PPOs, automating the complex “layered-claim” repricing process, which can include time-intensive and expensive off-line processing of out-of-network claims, including fee negotiations and wrap products.

While GTESS has offered primary repricing facilitation to its clients for several years, the expanded services offered through PPO Connect™ include enterprise-level electronic repricing connectivity with a continually expanding list of primary and secondary networks, web-reporting and tracking of claims. PPO Connect™ allows benefit administrators to capture greater discounts by gaining access to nationally recognized primary and secondary networks, and to submit claims electronically for fee negotiation. The service also dramatically reduces repricing-related overhead and costs.

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PPO Connect™ is built upon GTESS’ flexible and proprietary business process management system, and uses complex network selection logic to fully accommodate managed care situations, affording benefit administrators with unique repricing arrangements the same benefits. GTESS anticipates continual expansion of the list of PPOs offering this type of electronic facilitation.

“As competitive pressures increase for payers to provide the best claim discounts, access to fee negotiation and wrap products becomes critical,” said GTESS Vice President of Operations, Donna Fendley. “PPO Connect™ allows our clients to receive the additional discounts offered by these products while maintaining close control of all claims and reducing total cycle time.”

“One of the major barriers to high adjudication rates is claims submitted without repricing information, creating expensive and time-consuming exception processing. PPO Connect™ solves this problem,” said GTESS CEO & President Deborah M. Gage. “The GTESS trademark is to employ technology and increased connectivity to drive automation at key points in the claims payment process to increase auto-adjudication rates and decrease overhead expense.”

For information about these services, contact your GTESS Account Representative or John McGahey, GTESS Vice President of Sales and Account Management.

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.

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Karen Hallman
GTESS
972.792.5500