7300 Kendall Drive, Suite 700 Miami Florida 33156
786-694-2469
information@globalm3.com

Platinum Level Customer Service:

Exceptional Service, no surprises – that is the Global M3 way! When you call us, a real person will answer. No pre-recordings for our customers, you are too important to us for that! Our professional telephone agents will stay with you on the call until you are directed to the correct party. Platinum Level Customer Services from the first moment.

Before

Once we are notified of a medical necessity, one of our doctors will immediately begin to contact medical facilities and/or providers in the corresponding area. If the patient has already been admitted due to a medical emergency or crisis, one of our doctors will then immediately confer with the providers and/or facility to assure that your employee is receiving the best medical care and most appropriate medical treatment for his/her case. We will also begin negotiations of all medical costs to assure our client that all medical expenses are kept under control.

During

Our Case Management staff and doctors will continuously monitor our patients, communicating with all medical providers, following up with treatments, therapies, follow up visits and all medical necessities our patient may require. Assuring that our patient receives top quality care and keeping your costs under control all the while providing every customer with our Platinum Level Customer Service.

After

Once our patient is discharged, Global M3’s medical coordinators and doctors will coordinate all follow up treatment necessary. We will review all medical information and records and make sure that medical billing is within the pre-established rates that Global M3 would have already negotiated during the first step of our medical coordination process; therefore, providing our patient with the best medical care possible and our customer with the expected medical costs. Platinum Level Customer Service and No Surprises!


Competitive Discounts, Access and Stability

Our Network produces consistently outstanding results:

  • Comprehensive coverage in urban and rural markets ensures smooth, seamless coverage and treatment. Wide-ranging access and provider availability meets employers’ needs for inpatient and outpatient services
  • Flexible repricing solutions, including remote pricing and electronic submission, streamlining administration
  • Outstanding, Platinum Level customer service consistently supports clients, members and providers


With Our National PPO Network, Clients Enjoy:

Broad access

  • Approximately 4,700 hospitals
  • Approximately 500,000 doctors and health care professionals
  • 98% of the U.S. population has access to a provider in our network

Stability

  • More than 99% of hospitals remain with us year after year
  • More than 96% of doctors remain with us year after year

Carefully Credentialed Providers

We are 100% committed to patient safety and therefore exercise extreme care and carefully evaluate all providers before adding them to our network.


Our relationship with providers is an important part of our success. Our dedicated staff strives to resolve provider inquiries and concerns in a timely and efficient manner. We monitor our service for quality, turnaround time and provider satisfaction.



CLAIMS

Satisfying all of the requirements necessary in the processing of medical claims can be, at the very least, confusing. Global M3 has created solutions to questions such as:

  1. Is there a program that permits carriers to control their own claims process while eliminating all of the concerns associated with provider related costs?
    YES! Global M3 can meet all of your needs
  2. How can we make sure that we are getting the best in "provider management" from the start of a claim?
    Let Global M3 handle all of the claim and case management details for you. Your employee will receive top notch medical care and your medical costs will be under control
  3. Can we reduce the cost of processing and keep control of those processing parameters that are so important to my bottom line and policyholder satisfaction?
    YES! Global M3 will coordinate all medical care to keep your employee happy and you can rest assured that all medical costs to you will be controlled and within the usual and customary rates


Global M3 satisfies all of these provider management concerns.


Getting started is as easy as picking up the phone. First, we can analyze your current claims program. Next, we’ll tailor a claims management program to fit your company’s specific needs. Our services range from independent claims adjusting to providing third-party administration for self-insured organizations. We’ll work with you to determine the right fit for your company. With our customized system in place, you can rest assured that your claims reports will be accurate, on time; in line with what your plan was made to deliver to both the policyholder and the carrier. Feel free to contact us any time for inquiries on customer satisfaction.



REPRICING

Our "Specialty of the House" is repricing. Our 35 years of combined experience in both the US and International claim arenas has enabled us to provide the strongest repricing support in the industry. As part of this Support Structure we offer:

  • Expert Technical Support, Platinum Level Customer Service and professional ethics
  • Fast, accurate provider management and reporting
  • 24 Hour Service, following notification of claim
  • 200 combined years of insurance repricing experience



NETWORK

The Global M3 network is comprised of several National and International PPO’s and employs a substantial direct contract network throughout its primary service areas. We are currently in all 50 states, Canada, Mexico the Caribbean and throughout Latin America.

Global M3 takes pride in its efforts to direct our clients’ members to providers who participate in the Global M3 Network. We use a variety of measures to make members aware of hospitals, primary care physicians, specialists, freestanding X-ray, ambulatory surgery centers and other types of ancillary health care professionals that are available. We channel members to network providers when they contact us by telephone. In addition, participating providers have 24 hour access to our provider referral service so they can refer members to participating hospitals, specialists and ancillary health care providers when medically appropriate.

Global M3 requires that the Global M3 Network be referenced on member ID cards, on group health explanations of benefits and carrier referral sheets. We also require our clients to utilize benefit plan incentives to encourage the use of contracted providers. We provide members with communication materials that clearly outline the advantages of using network providers.

Global M3 clients who have access to the network include various group health, managed care and compensation payers such as:

  • National and International employers
  • National and International Insurance carriers
  • National and International Third Party Administrators (TPA’s)


The value of the services we provide our clients is easily identifiable through our:

  • Requiring benefit plan incentives
  • Telephonic and site provider directories
  • Communication materials
  • I.D. cards
  • Redirection, if required during the utilization management process.
  • Hassle-free administrative procedures
  • Standardized billing statements.
  • An experienced clinical management staff of medical professionals
  • Professional provider relations unit for rapid response to concerns
  • More than 4,500 Hospitals.
  • Network Databases with a wide array of National and International medical specialists.



UTILIZATION MANAGEMENT

Global M3 has configured a wide array of utilization management programs to serve the interests of health insurance companies, third party administrators, self-funded employer plans, hospital business offices, medical practices, reinsurance carriers and the legal profession. Because we interface with both carriers and providers we are thoroughly versed in those processes that clearly maximize results for our clients.

We pride ourselves on our commitment to quality of service. Our professional audit and case management personnel have acquired the Associate, Customer Service (ACS) designation, sponsored by Life Office Management Association (LOMA). LOMA provides one of the leading insurance specific educational programs in the industry today, encompassing topics such as Operations, Administration, Legal Aspects of Life and Health Insurance, Accounting, Information Systems, Profitability and Solvency, Reinsurance, and Regulatory Compliance.

Our flexible fee schedules are built to provide any potential user with a rate structure to meet their project needs. Our services and fees can be tailored to provide hourly, project, or incentive-based fee structures. Global M3 specializes in a variety of case management styles to better assist you with your specific medical concern.

CASE MANAGEMENT

Global M3 has established an extensive system of criteria so that potentially large claims are recognized early. Global M3 then begins a review of the case and determines needs in terms of managed care. Our registered nurses negotiate pricing, contact on-site managers, ensure that the physician’s plans of treatment are being administered correctly, and monitor billing. Our case managers and claims examiners know your Plan Benefits and Requirements and provide an invaluable coordination of these requirements with the health care providers.

On Site Case Management includes:

Standard Patient visits to hospital/rehab facility Telephonic Case Management
  1. Record Review for criteria compliance
  2. Participation in patient case conference
  3. Discharge Planning and Home Health Care arrangement
  4. Durable Medical Equipment arrangement
  5. Home visits to patient (if needed)
  6. Report preparation
  7. On-site Case Management (in or out of area)
  8. Acquisition of medical records, x-rays, etc

All of the Standard Patient Benefits, plus

  1. Accompany patient to physician visits
  2. Assistance with short or long term housing
  3. Assist patient with errands



UTILIZATION REVIEW

Global M3 offers a total package Utilization Review Program, specifically tailored to include the 2 most important areas of Utilization Review.

Pre-admission Review and Certification

The objective of this process is to reduce expenditures for in-patient acute care by monitoring the utilization of in-patient hospital care and offering patients appropriate alternative services. This process includes:

  1. Notification of admission by employee, hospital, or physician
  2. Notification in writing of criteria met and approved
  3. Referral to Case Management
  4. Referral to Physician Reviewer


Concurrent Review and Discharge Planning

Global M3 will continue to monitor an in-patient hospital stay to verify medical criteria of hospital days. Planning for discharge is an integral component of the concurrent review process. Step-down units, home health, and outpatient physical therapy are among the alternatives open to a patient upon discharge.

  • Certification of additional days
  • Physician referral if not certified or non-participating
  • Denial and appeal if appropriate
  • Referral to case management


Retrospective utilization reviews are also conducted to ensure that the services provided were necessary to the care and treatments were reasonable and customary, both as to the amount paid and discounted as well as the appropriateness of care. The results of the review are then reported to the providers. Appropriate steps are taken to mediate discrepancies so that balance billing of the participant is prevented.



AUDITING SERVICES

Whether you’re insured, uninsured or self-insured, Global M3 can help audit your bills and save you money you thought you didn’t have. We can cut health care costs and lower the overall cost of operation for any organization.

In our audit of claims and cases, Global M3 goes through your chart with a fine toothcomb in order to save your company hard earned money, something most insurance carriers do not include as part of their auditing process. Most carriers don’t have the time, expertise or personnel to do the job properly. Global M3 can also provide other prospective services for prevention of diseases and maintenance of good health, reducing your dependence on future audit requirements. Global M3 will provide you with information and tips as well, to save money during hospitalization. In doing so, we can help decrease your health care costs, therefore increasing your profitability.

Medical Bill Audit

At Global M3 our audit goal is to assure that policyholders receive the services for which they are charged. Because we have already diligently determined the appropriateness of medical treatment, when performing a Medical Bill Audit we can focus strictly making sure charges are fair and correct.

Global M3’s only concern while performing this audit is whether or not the policyholder, employee, or crewmember did indeed receive each item or service that appears on the bill and the necessity of each procedure. (We will audit bills up to but not older than 2 years.)

Global M3 will review the Chart for compliance of usual, customary and reasonable charges as well as inappropriate billing practices. Below are the areas covered in Global M3’s review and audit of your medical bills:

  • Charges exceeding the maximum allowed
  • Up-Coding
  • Unnecessary Ancillary Service
  • Unbundling of Laboratory Tests
  • Global Surgery Fees
  • Double Billing
  • Bilateral Surgeries
  • Unrelated Diagnosis and Treatment
  • Extended Length of Stay
  • Errors in Room Charges
  • Medication Errors and overcharges


Medical Records Review

First, Global M3 organizes, tabulates and chronologically arranges the medical records in a logical fashion that is easy to follow and understand. This includes separating the contents by dates and occurrences, then providing a table of contents and separating them by volume if needed. Global M3 provides timely and detailed review followed by a concise report of the findings. We will identify causation; recommend potential dependents, and review hospital policies and procedures.

Documentation of Audit/Medical Review

Global M3 provides a detailed hard copy report, reflecting identified discrepancies, which have been discussed with Hospital/Agency for discounts and/or reductions in Hospital Bills, or a detailed medical record summary report if a medical record review is performed. As trained Hospital Analysts, we take all the mystery out of checking your bills, or reviewing records for appropriate medical care. We know how and where these errors occur and can assist you in reducing and/or recovering these overcharges, and/or evaluating whether the medical care and treatment received was justified and appropriate.

SPECIALIZED REPORTING CAPABILITIES

Global M3 utilizes a modular system that permits immediate generation of multiple reports for insurance carriers, reinsurers, third party administrators, and networks. This broad range of capability permits Global M3 to configure client reports to their requested specifications.