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Our extensive background includes competent processing at a management level on medical, dental, disability claims, death benefits, auditing of claims in accordance with established procedures and/or contracts.

  • Counseling, training and guidance provided on complete claims processing and underwriting issues.
  • Review and approval of surgical, medical and dental procedures.
  • Preparation of international claims guidelines, training of business partners/clients on claims processing skills, pre-existing, appeals and refunds.
  • Reinsurance of domestic and international market experience.
  • Excellent customer service skills.
  • Services include but not limited to pre-certification, utilization review and case management.
 
Claims Processing
  • Complete Claims processing.
  • Printing EOB for Provider of Service & Insurers
  • Printing Check-EOB for providers of Service & Reimbursement for Insurers.
  • Mailing Check for claims payment.
  • Investigation needs according to the requirements of the Policy.
    • Preexisting investigations.
    • Medical Necessity.
  • Diagnosis vs. procedure/treatment.
    • Diagnostic procedure (is it done for preventive purposes as routine) check up/only allow non-invasive procedures (no general anesthesia).
    • Diagnostic procedures done with no basis.
    • CAT Scan.
    • MRI.
    • Rehabilitation programs as physical therapy, occupational therapy, speech therapy, pulmonary or cardiac rehabilitation therapy, therapy involving the manipulation of bones, etc.
  • PRN or Preventive Basis vs. Medical Necessity.
  • DME vs. condition of patient.
  • Treatment vs. the amount of or length of treatment.
    • Physical Therapy.
    • Chiropractic Services.
  • Hospital inpatient length-of-stay.
  • Inpatient surgery vs. outpatient surgery.
  • URC (Usual Reasonable & Customary) review.
  • Assistant Surgeon.
    • Recommendation latest Physicians as Assistants at Surgery edition prepared by the American College of Surgeons.
  • Co-surgeon.
  • Stand-By Physician.
  • Nursing Services.
  • Precertification/Utilization Review.
  • Monthly reporting system to facilitate information to our Clients.
  • Quarterly special reports.
  • Annual special reports and analysis of the utilization of medical services.
  • Internal audits to keep International Claims Specialist meeting all criteria’s goals & expectations of quality.
 
Specialized Customer Service Need
  • Personalized Customer Service - assistance for coordination of services, list and general information of Physicians and Hospitals.
  • Claims Status.
  • 24-hr. emergency services.
  • Coordination of air transportation to the nearest ports of medical service.
  • 800 International Toll-Free access.
  • Network steering to assure savings to Client.
  • Verification of benefits.
  • Educational Services to Insureds for better understanding of their Policy.
  • Pre-certification, Medical Consultation, General Information Requests and e-mail through our website at www.globalhealthclaims.com.
  • Utilization Review.
  • Appeals Review.
  • Case Management.
  • Cost containment services.
 
Enrollment Maintenance
  • Maintenance of Eligibility records.
  • Enrollment reports.
  • Maintenance of dependants who will be out of coverage after their age limit. Reporting to Client the possible candidates for an individual coverage so it can be offered without lapsing the individual’s coverage.
  • Guidance & printing Identification Card.
 
Internal Repricing Services with Worldwide Provider Network
  • Repricing Services internally to assure timeframe of 30 days claims processing. Our goal is to issue checks & EOB’s in 15 to 20 days.
  • Guidance to access a nationwide hospital & health care facility network.
  • Coordinate health treatment with state of the art Concierge Service.
 
Additional Services
  • Real time server access for Customer Services in their Country.
  • Participation on Policy changes to better the benefits of the Policy.
  • On-site claims training to International Clients.
  • Set up in house claims departments for better customer service.
  • Audits.

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