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