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Our complete range of solutions falls into four distinct categories

Large / Catastrophic / Major Medical Claim Management

Peace of mind.

For over 20 years, we’ve honed and refined our large claim management techniques, providing catastrophic claims services for both international and U.S.-based domestic claims. Our comprehensive range of services allows us to address the unique needs of insurers, reinsurers, assistance companies and U.S.-based TPAs, including some of the largest in the world.  Our large claim management techniques have been honed and refined for over 20 years – they work and they work very well.

Global Excel works very closely with the insurer and if requested, the insured, to ensure “peace of mind” during the entire process. Claims of this nature can be extremely complex and our goal is to ensure transparency for all, from the beginning to the end.

This includes the risk taker, any assistance company involved, possibly the insured and naturally the healthcare provider. Any financial arrangements made are locked in and completely signed off by the provider, with the insurer being in control at all times. We combine the best of our services to minimize the net co-payments for major medical cases, catastrophic cases or high value cases.

Effective steerage & negotiation

Using a suite of proprietary tools Global Excel is able to compile a list of potential providers uniquely qualified to treat practically any condition.

When evaluating potential providers, true value is really a combination of the quality of treatment and the associated costs. In our industry, consideration for both quality and costs is virtually non-existent when evaluating a provider. For many years, Global Excel routinely encountered hospitals with some of the lowest quality ratings billing some of the highest charges in the country.

Our FairChex tool was developed to combine both these factors together, essentially aligning a facility’s quality with its charges. The data used is completely objective – provider quality information is updated routinely from CareChex, an independent third party quality analysis firm, and the financial data is sourced from the U.S. government. FairChex allows us to compare any number of potential U.S. providers, including providers that may have been ‘recommended’ to the insured.

Global Excel is the only cost containment partner that routinely uses a cost-quality tool for pre-admission analysis. Once an appropriate provider has been identified and selected by the insurer/insured, Global Excel will then pre-negotiate the financial arrangements with that provider.

Medical case management with GEMClinical TM

Proactive case management is absolutely essential to managing healthcare costs. It is at this stage that cost avoidance becomes key. Without proper case management a large claim can quickly become catastrophic – simply because of lack of medical and financial oversight. There are always options – but if you don’t know what they are, it’s tough to avoid the dangers. Our GEMClinical tool is the ideal solution to help international assistance companies and insurers manage their difficult inpatient cases occurring in the USA. GEMClinical allows our corporate client to retain all contact with the patient, as well as all decision making power with regards to the medical treatment provided by U.S. facilities. Global Excel gathers the necessary medical information from the provider, summarizes it and shares it with our corporate client in a structured report. We reference industry-approved care guidelines to assist our client with effectively overseeing care and avoiding overtreatment. Our doctors and nurses have an intimate understanding of how the U.S. system works and we use that expertise to provide our own medical recommendations pertaining to continued treatment, fit-to-fly, alternative treatment options and (when applicable) cost-benefit analyses comparing optional care scenarios. Our medical team is always available to answer any questions our clients may have.

Back-end negotiation and claims administration

Unfortunately not every case develops as it should and often insurers or assistance companies only learn of an admission… even a large one… after the fact. Global Excel can help here as well.

There is no question that the earlier you can intervene in a case, the greater your potential for controlling the ultimate costs. But in circumstances where the patient has already been discharged and that hospital has already billed the insurer, Global Excel’s ‘blended approach’ to cost containment can be applied very effectively.

Our expert negotiators will examine the bills and benchmark the charges against objective cost data. We communicate the various options back to the insurer and allow them to make the final choice on how to proceed. The key thing is that the client has the ultimate control – our job is to outline the opportunities, provide advice and then to execute the client’s final decision.

Global Excel also offers the complete range of claim administration services. From bill scanning and triage through to bill editing, adjudication and payment. All these tasks are wrapped in a comprehensive Quality Assurance program that assures consistent and accurate processing. Our Online Portal allows you to follow the entire process from beginning to end.

Transparent reporting is key – if you don’t know how your claims dollars are being spent, how can you adjust your strategy to compensate?

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