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