News and Events

GTESS Corporation Announces Repricing Capability

(Richardson, Texas -- February 5, 2003) – GTESS Corporation, a leading provider of outsourced business process services to the healthcare industry, today announced new repricing facilitation capabilities for its healthcare payor clients. With this service, clients gain significant operating efficiencies for outsourcing the pre-adjudication processing of all claims -- even those requiring repricing by a third party – to GTESS. GTESS currently facilitates claims repricing for several PPO (preferred provider organization) networks, including Beech Street and PHCS. With repricing facilitation, GTESS receives claims electronically or via the mail directly from healthcare providers. The Company then uses patient membership data to select the proper provider network, formats the claim into the HIPAA-compliant format and electronically forwards any claim requiring repricing to the appropriate network. The network matches the claim to a fee schedule and electronically returns the repricing information and the claim to GTESS. Finally, GTESS performs additional edits and re-formats the claim for delivery to its payor clients, who can monitor the entire process using a web-based claims status system. GTESS CEO and President, Deborah M. Gage, said, "Repricing has always been a costly headache for healthcare payors." "Until electronic repricing facilitation, repriced claims required human intervention, multiple-step handling and additional cost." "We’re pleased that our clients can now extend their outsourcing to claims requiring repricing, thus achieving additional savings." said Gage. GTESS Corporation offers significant operating efficiencies to the healthcare industry through a range of outsourced solutions that streamline electronic claims processing. The company specializes in providing full front-end services, from receipt and validation of paper or electronic claims to repricing, coordination of benefits, and correspondence and document management. By receiving "clean claims" in HIPAA-compliant formats, GTESS clients dramatically reduce their costs, while achieving higher auto-adjudication rates, maintaining peak-level processing capacity and eliminating their backlog – all with guaranteed turnaround time and data accuracy.

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Karen Hallman
GTESS
972.792.5500