Administrative Support
With the complexity of our health care system and the multitude of insurance carriers, facilities, and providers, each maintaining their own set of policies, procedures, and clinical criteria, it is no wonder individuals become stressed and feel lost when trying to advocate for themselves or their family members.
We, at Genuine Healthcare Resources, assist individuals and caregivers by providing exceptional administrative support; our Health Care Advocates diligently seek maximum resolution by holding all those involved accountable.
We, at Genuine Healthcare Resources, assist individuals and caregivers by providing exceptional administrative support; our Health Care Advocates diligently seek maximum resolution by holding all those involved accountable.
- Resolve issues with medical bills & claims.
- Research & assist in coordination of benefits (COB).
- Resolve Pharmacy Benefit confusion, including generics vs. brand name (See Clinical & Care Management Support).
- Review all facility and provider bills against insurance EOB’s (Explanation of Benefits) to ensure appropriate billing and maximum claims reimbursement.
- Resolve insurance issues, ensuring application of individual’s FULL Benefits.
- Assist individuals and physicians with Preauthorization Requests.
- Advise individuals and physicians on the appropriate use of out-of-network providers, and how to obtain approval BEFORE services are rendered.
- Counsel individuals and their caregivers on their member handbook, their benefits, including their Drug Formulary List.
- Provide guidance & assistance on all Appeals, Member Grievances, etc. (See Member & Provider Appeal Section).
- Advise individuals and physicians on the use of capitated providers, what it means, and the process to request an ‘out of cap’ approval.
- Seek to renegotiate provider & facility fees.