Payer Solutions

Why GeBBS?

  • U.S.-based company
  • Multiple global delivery centers in three countries
    • U.S
    • India
    • Manila
  • U.S.-based oversight and implementations

GeBBS’ Payer Solutions improves government payers and risk-bearing providers management of contracts. Our payer solutions allow clients to improve their risk adjustment and quality programs by giving them a complete platform that gives them actionable data and solutions to act on them.

With the largest health plans and healthcare organizations as clients, GeBBS is well-respected for providing some of the highest results in the industry around risk adjustment coding (HCC coding), HEDIS abstraction and retrieval. This is accomplished with a technology-enabled platform, exceptional project management and focus around client satisfaction.  We partner with our clients to emphasize transparency and trust and appreciate the opportunity to become a valuable extension of your team every step of the way.

Our proprietary technology platform provides flexibility to choose the services and platforms you need to be successful. We provide global resources and a variety of services, workflows and platforms – all of which can be customized to your needs.

GeBBS Risk Adjustment Services

Getting the most out of risk adjustment programs requires the right technology and resources with an expert focus on risk adjustment. This comes with an in-depth evaluation and a 360 degree look at your data and initiatives. An outside look is often the most effective way to truly get it right. Whether you’re a payer or a risk-bearing provider, we make sure you get the right RAF score and help you maximize the impact. Our risk adjustment platform provides an accurate, real-time look at your risk scores – based on a comprehensive and ongoing review of your data. Our proven service delivery model takes chart review to the highest level, ensuring timeliness, quality, accurate documentation and optimal results.

Our continuum of risk adjustment services includes:

  • Medical Record Retrieval 

  • GeBBS is committed to collecting every relevant medical record, coding each one correctly and delivering reliable, accurate results. Our proprietary iCode technology and provider-sensitive processes support greater engagement, and satisfaction among providers. Chart recovery methods offer providers a lot of flexibility and reduce provider abrasion. They are HIPAA-compliant, tested, and secure; they include provider portals with drag and drop capability, EMR integration and EMR CCD data exchange along with onsite retrieval, fax, and mail. Our unique dashboard provides full transparency into real-time chart retrieval status.

  • Risk Adjustment Chart Review (HCC coding)

  • We offer chart review options that give you flexibility and allow you to affect RAF score and documentation improvement:

    Concurrent Chart Review

    • Provides immediate review of the record
    • Review risk adjustment conditions at time of visit
    • Real-time query for provider clarification

    Retrospective Chart Review

    • Blind coding reviews
    • Claims data validation
    • Identify opportunities for provider education/training

    Within each review, we support your organization’s efforts to capture all risk adjusted diagnoses and ensure members are appropriately risk-adjusted. Our fully employed team of over 2,000 coders can scale quickly and complete projects of any size. We offer a full-service HCC coding solution for all risk adjustment coding: ACA-Commercial, Medicare Advantage, and Managed Medicaid. Our compliance-based approach to medical record coding is delivered by AAPC or AHIMA certified coders who capture or suggest deletion of risk adjusting diagnostic codes and can also perform data validation audits. GeBBS coders are trained to identify conditions for provider education that do not meet CMS criteria based on documentation. This information is packaged in actionable reports.

  • RAF Score Reporting 

  • GeBBS real-time risk adjustment detail dashboard and reporting illustrate your plan, group and down to the members’ total RAF score. We can show additions and deletions of diagnosis and how it affects your overall RAF score and how to improve it with proper education and documentation.

  • HEDIS Abstraction/Workflow & Solutions

  • Our HEDIS solutions provide a real-time look at your performance – allowing payers to improve care delivery, quality and member satisfaction.

    • Best record approach to find the right measures in the right place
    • Identify gaps in care and improve quality
    • Real-time compliance reporting by measure
    • Built-in workflow for external overreads and MRRV audits
    • Maintaining cost-effective practices
    • Unprecedented transparency using GeBBS web-based management platform
  • Provider Education & Support

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    Our provider education platform gives you a comprehensive view to identify opportunities for provider education and feedback. Our platform allows you to review trending reports and education by provider, specialty or HCC category. This allows you to see where you need to give your providers education and allows you to show them how their results compare to the overall health plans, groups and peers.

  • Risk Bearing Providers/IPA’s

  • With over 100 provider clients, GeBBS is deeply rooted in the provider market. We understand how to work with provider groups and help them get the most out not only their risk adjustment and quality programs program but the ability to offer solutions that meet all their needs including professional fee coding, A/R, patient contact, and other RCM solutions.

    Our proprietary enterprise technology platform addresses critical pain points for payers with its chart retrieval feature, concurrent review capabilities, and ability to capture HEDIS and STAR measures. GeBBS’ iCode Risk Adjustment (iCRA) technology is an intelligent workflow tool used by payers to perform risk adjustment and quality initiatives utilizing a self-service tool. It also gives you the flexibility to use internal and vendor resources that best fits your needs.

Learn More

News Release | April 21, 2017