CONSULTING & LIASON SERVICES
GCHMO Consulting & Liaison Services
GCHMO acts as a liaison between our providers and the HMOs.
As a provider’s liaison, GCHMO will:
- Obtain out-of-network authorization or single-case agreements when the provider is out-of-network with an HMO
- Determine patient eligibility, coverage and benefits
- Obtain carve-outs for high-cost medications and DME
- Answer questions on HMO reimbursement rates and policies
- Work to collect outstanding old monies for the provider
- Identify the reason for claim denials and ensure claims are paid
- Create quickguides for each HMO contract the provider owns that outlines the rates, revenue codes, level descriptions and carve outs of the contract.
- Address all questions and issues in regard to HMOs that need attention