Global Healthcare Alliance, Inc.

Global Healthcare Alliance unique enterprise software system for healthcare benefits administration lets companies focus on building their business, not on the complexities of claims administration and processing. Providing a full service Revenue Cycle Management solution for physicians and fully customizable application for HMOs, TPAs, IPAs, MSOs our business solutions helps you stay current and competitive.

Situation

According to the National Coalition on Health Care, healthcare spending is projected to exceed $2.3 trillion by 2009, therefore, it is critical that both the provider and payer control their claims processing costs by utilizing technology that improves efficiency, enables business-to-business electronic transactions, and allows the continuity of care for patient records.

As the cost of running a practice continues to increase due to higher malpractice insurance, more complex services to patients, and the ever increasing number of the uninsured, physicians are vulnerable to loss in revenue or worse the loss of a practice if their reimbursements are not processed efficiently and correctly.

In addition, payers are susceptible to escalating operational costs in relation to processing physician reimbursement claims that are not billed correctly, but if a technology solution exists that improves the workflow and overhead for the payers, the reduction of those operational costs can ultimately be passed back to the consumer.

Solution

Global Healthcare Alliance, Inc. has over 20 years experience as both a healthcare payer and provider, and with that experience, developed a software solution with the functionality to span the entire healthcare transaction to improve electronic claims processing for payers and providers. SystemMSO, for providers, and SystemHMO, for payers, were created from the same system platform built on innovative software and electronic data interchange technology.

SystemMSO and SystemHMO benefit the provider, payer, and patient alike. Our claims system with electronic data interchange technology improves the overall costs and efficiency while maintaining the continuity of care. The solution confronts each constituent in the healthcare cycle by allowing physicians to concentrate on their patients not claims administration, enabling the payer to increase efficiency in claims processing, and for patients to have their records integrated and accessible across any system.

Global's innovation is a hybrid of software, hardware, and web-based ASP services to seamlessly move claims quickly and securely. SystemMSO and SystemHMO have the capacity necessary to process and manage large volumes of claims efficiently and effectively with proven reduced costs. SystemMSO and SystemHMO were recognized as First Place, “Technology for Improvement of Claims Processing” and Best of Show for “Technology of the Year” at the 2005 TETHIE Awards. According to Mr. Mark Anderson, Chief Executive Officer of AC Group, Inc. and TETHIE judge for the past three years, "Global not only provides a great product, but an entire 'solution' to the issues facing HMO's, MSO's, and physician practices today.”

Better Health & Lower Costs

Developed for providers, from a payer’s perspective, SystemMSO includes an intelligent built-in claims scrubbing engine that validates fields, coding, and payment rules before claims are billed. A third party independent study has shown that first pass claim rates can improve from 60% to over 90% within three months*. SystemMSO’s first pass claim rate is 98.6% surpassing the industry standard.

SystemHMO addresses all areas of costs, speed of processing, and volume of transactions with a proven 50% reduction in claims processing staff. A built-in, rules based claims scrubbing engine re-prices or auto adjudicates claims without manual intervention, thereby, reducing the overhead costs required and increasing the ability to administer a larger volume of claims. An industry survey suggests that a process that takes in a larger volume of claims, processing, and distributing payment concurrently has a cost savings of more than $4PMPM*.