Cost Containment & Travel for Treatment Services · U.S. Cost Cost Containment Containment & Travel...
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Global Corporate Solutions Cost Containment & Travel for Treatment Services
Transcript of Cost Containment & Travel for Treatment Services · U.S. Cost Cost Containment Containment & Travel...
Global Corporate Solutions
Cost Containment & Travel for Treatment Services
Our world-class health management solutions, including Cost Containment and Travel for Treatment are constantly evolving to ensure our international and domestic clients have a complete set of leading solutions.
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About Us
Founded in 1995, the Europ Assistance - Global Corporate Solutions (GCS) ITPA Division is a leading international third party administrator (TPA) and health management company that assists insurance companies, government entities, and their insured members to confidently navigate increasingly complex global healthcare systems with the benefits of our 5 decades of assistance experience and leveraging the economic advantages of our unmatched global healthcare provider network with ease.
Our North American and international proprietary provider network, medical case management, strong claims processing systems, customized services and technology are all seamlessly interwoven to ensure patients receive the best-possible medical care, while reducing and controlling our clients’ risks and costs.
OUR MISSION
“Managing with Care” - managing global healthcare and insurance programs to the highest levels of client satisfaction, patient satisfaction and cost reduction.
OUR GLOBAL REACH
As a member of the Europ Assistance Group, pioneer of the Assistance concept 50 years ago, we have a presence on five continents, and a network consisting of over 10,000 acute care facilities and over 600,000 physicians across 130 countries, we are your most experienced and trusted partner for unrivaled access to the best medical care in the world.
• Credentialed provider network in over 130 countries
• Over $800 million in travel for treatment bills processed per year
• 300 million customers covered by Europ Assistance or its partners
• Ground agents located in 208 countries and territories
• 35 customer assistance centers located around the globe
• An average of 12.4 million assistance cases opened per year
• 6,010 air ambulance flying hours to repatriate Group customers
• An average of 62 million calls handled per year
• Over 8,000 employees worldwide
*Based on 2012 Europ Assistance Group Key Figures
"Recognized as the service leader for
borderless healthcare managment and cost
containment."
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Our Services
Our world-class health management solutions, including Cost Containment & Travel for Treatment are constantly evolving to ensure our international and domestic clients have a complete set of leading solutions to manage the three universal fundamentals of healthcare: Access, Quality and Cost.
Backed by strong systems and processes, highly experienced management and skilled staff, our health management solutions deliver important value to our clients and their insured members on a daily basis.
OUR COST CONTAINMENT & TRAVEL FOR TREATMENT SERVICES INCLUDE:
COST CONTAINMENT TRAVEL FOR TREATMENT
Corporate Medical NetworkTM
U.S. Cost Containment
Large Claim Review & Audit
24/7 Medical Case Management & Emergency Assistance
Claims Management & Repricing
Corporate Medical NetworkTM
Claims Management & Repricing
Large Claim Review & Audit
24/7 Medical Case Management & Emergency
Assistance
U.S. Cost ContainmentCost
Containment &
Travel for Treatment Services
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Corporate Medical NetworkTM
We continually work to enhance and expand our Corporate Medical Network™ (CMNTM). New contracts are signed on a daily basis and the network includes industry leading hospitals, doctors, specialists, dentists and other medical providers in over 130 countries.
We know that members need more than just hospitals for their daily healthcare needs. The main contributing factor to any successful healthcare plan is to have access to a broad range of healthcare services and providers. The CMN™ covers a comprehensive range of healthcare specialties and fields including specialized diagnostics testing, labs, neo-natal care, cardiac care, serious trauma injuries or burns, oncology, orthopedic, general to specialized surgery, organ transplants and occupational medicine.
More important than the size of the network, is the quality of the providers selected.
Our team of dedicated Provider Relations Network Specialists is actively contracting with healthcare providers around the globe. In order to ensure we are consistently working with the best providers at the best price, we regularly review and evaluate our contractual relationships with all our providers while building relationships with the best providers in the region.
10,000 acute care facilities
Over 600,000 physicians across 130 countries
Over 5,000 international facilities with cashless service
A Worldwide Presence by Europ Assistance
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"Unparalleled direct contract provider
network with industry leading discounts"
Our long history of bringing people to the U.S. to access healthcare has allowed us to build an unparalleled direct contract provider network with industry leading discounts.
Combine our direct network, along with access to best-in-class HMO and PPO networks, and refined cost-based negotiations for a solution that will help reduce our client’s healthcare costs.
Our capabilities and performance in the U.S. market include:
• Over $500 million worth of U.S. medical bills and over 300,000 claims processed every year
• Highest net savings in the industry
• Broad access
• Best in class discounts with key Centers of Excellence
U.S. Cost Containment
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Unique to the market, our large claim review and audits result in a signed agreement with the billing provider, ensuring that the settlement is never disputed.
Our large claim review and audit services provide clients with a full claims audit that includes line-by-line reviews of billed charges to identify and exclude any technical and coding accuracy errors. This results in claims charges being reduced before the application of the discount or reimbursement. In addition, this service can be applied to claims that are in or out-of-network.
Our review and audit services include:
• Review of medical necessity
• Unbundling of charges
• Utilization review
• Anesthesia services review
• Supplies, materials and durable medical equipment (DME) review
• Determining the room & board reimbursement rate
• Comparison of charges against the hospital documentation
"Signed agreement with the billing
provider, ensuring that the settlement is
never disputed"
Large Claim Review & Audit
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"Our goal is to provide empathetic patient advocacy, while effectively monitoring and
managing our clients’ costs"
24/7 Medical Case Management & Emergency Assistance
We “Know the Deal”.
Our highly trained and experienced medical management team works together to manage all aspects of a case; from initial contact to completion of medical treatment. Our goal is to provide empathetic patient advocacy, while effectively monitoring and managing our clients’ costs. With a centralized hub located in Toronto, Canada, we provide 24/7, 365-days-a-year access to:
• Dedicated multilingual case management and assistance teams
• 22 nurses and 3 physicians who provide medical management and oversight
• Support in accessing emergency, routine and planned tertiary care
• Pre-authorizations/pre-certifications
• Steerage of patients to cost effective providers while maximizing available benefits, coordination of admissions, monitoring of treatment, as well as constant patient support
• Coordination of air ambulance and commercial evacuation
• Cashless billing coordination
• Bed find specialists
• Direct toll free numbers or assisted toll free numbers to allow members easy access to reach the assistance centre 24/7
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Our medical claims experience covers all facets of the claims process and is backed by a system that allows for customized support and tracking of each client’s specific processes and needs. Our detailed reporting and consultative analysis further enhances these partnerships.
We work with our clients to create a specific claims management process that works for their needs. Our commitment to managing our clients’ claims includes the following services:
• EDI or customized file exchange
• Complete TPA outsourced solution
• Adjudication on our system or our clients system
• Robust client portal
HOW WE IMPROVE SERVICE
The following chart illustrates how our claims team has significantly improved the claims turnaround time for one of our clients after taking over the business from another health insurance carrier.
CLAIMS TURN AROUND TIME - PERCENTAGE OF CLAIMS PAID WITHIN 5 DAYS
Claims Management & Repricing
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Frequently Asked Questions
Is the Europ Assistance - Global Corporate Solutions (GCS) ITPA Division a medical services provider?
No. The GCS - ITPA Division is a leading international third party administrator (TPA) and health management company that works with our clients, insured members and healthcare providers to facilitate the provision of covered health care services. We provide medical assistance and claims administration services accommodating both the insured members and the healthcare providers servicing them.
How big is the Corporate Medical Network™ (CMNTM) preferred provider organization (PPO) network?
The CMNTM global PPO network consists of 10,000 acute care facilities and over 600,000 physicians and specialists in 130 countries.
What health specialties are offered through the CMNTM PPO network?
The CMNTM network covers all medical specialties including specialized diagnostics testing, neo-natal care, cardiac care, serious trauma injuries or burns, oncology, orthopedic, general and specialized surgery, and organ transplants.
Is the CMNTM PPO network based only in North America?
No. Through the CMNTM global network, we provide access to healthcare providers all over the world.
How do I get in touch with the GCS - ITPA Division?
You can contact the GCS - ITPA Division from anywhere in the world. From North America and most Caribbean islands, you can call us toll free at 1.800.310.6970. You can also call us collect at +1.905.669.4333.
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Why the GCS - ITPA Division?
We treat the patient like family and the money as if it were our own.
www.gcs.europ-assistance.com
EUROPE FRANCEPARIS (Headquarters)Tel. +33 1 58 34 23 79
GERMANYBERLINTel. +49 173 35 99 000
AFRICA
SOUTH AFRICAJOHANNESBURGTel. +27 11 991 9032
ASIA PACIFIC
SINGAPORESINGAPORETel. +65 8338 2259
NORTH AMERICA
CANADATORONTOTel. +1 905 669 7121
USASUNRISE, FLTel. +1 954 370 6404
LATIN AMERICA,ANGOLA & MOZAMBIQUE
PORTUGALLISBONTel. +351 938 736 645
Contact details of your nearest GCS officeEmail: [email protected]
