Navigating the world of HMOs can be daunting. Guidance Care HMO (GCHMO) is your low-cost highly effective alternative to having a full-time staff member perform any or all of your managed care contracting and related services.
Consulting and Liaison Service:
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
Achieve your revenue cycle management goals. When in-house collections departments are swamped with current billing, aging or difficult accounts can get pushed aside until a “tomorrow” that may never come. But you don’t have to let these valuable revenues disappear.
Ensuring uninterrupted coverage of a managed care patient’s stay in long term care or rehab can be very complex. For administrators working on very tight budgets, every benefit or reimbursement dollar that isn’t captured can directly impact your successful operations.
Accounts Receivables and Payables:
GCHMO manages our provider’s accounts receivables, and provides a comprehensive solution for all business office responsibilities. Using our extensive managed care experience, we prevent countless unnecessary claim denials. If claims are denied, we use our key relationships and in-depth knowledge to ensure our providers are reimbursed swiftly.
GCHMO is here to help medical providers enroll their patients onto Medicaid. Our Medicaid team handles the entire Medicaid process. We manage everything including gathering required documents and paperwork, completing applications, speaking with the state and managing all the countless, significant details until the final Medicaid approval.