December 27, 2016

General Medical Cost Management


It’s great when your clients tell you what they need from you next! So in 2016, we answered the need of our clients by partnering with another established firm to be able to impact all types of claims as well as Out of Network (OON) and Reference Based Payments/Pricing (RBP).  It’s important to understand that when using RBP patient balance billing is always a potential issue.  The question you want to ask is if you’re doing RBP what support is in place to address provider appeals and patient balance billing.  The provider has not agreed to accept your RBP as payment in full by contract.  We just like being upfront about things.

We can help our clients better manage the costs of all types of claims through our partner affiliation.

    • Reference Based Payments
      Leveraging existing plan document language and benefits backed by UCS when the language is appropriate.
    • Out of Network Claims
      There may be better ways to meet your requirements to conserve plan assets when dealing with OON claims.  Many of our clients are breathing easier with more manageable OON claims payments.
    • Behavioral Health and Drug Addiction
      Our partners offer guaranteed cost management for these claims have traditionally been back breakers for many plans. This solution has helped our clients pay more manageable amounts for this much needed care.
    • MedSurg
      Our partners offer guaranteed payments and cost management on MedSurg cases.


Contact Polli Yount to learn more about how GTSN can help you and your clients.

Polli Yount
Senior VP and COO
[email protected]