GIGI is a revolutionary, data-driven algorithm supported by machine learning, designed to predict the likelihood of a medical request’s certification at UR with a 92% accuracy level. Importantly, current state of the art “guideline lookup” apps only provide guidance on requests involving CPT related services accounting for around 40% of all requests. GIGI addresses all medical groups incorporating all medical services as well as pharmacy, DME-POS, and others.
“In addition,” Schlueter said, “GIGI can provide MFS cost data on covered services at the patient’s zip code level.”
GIGI may be accessed as a SaaS via API and integrated within a client’s existing claims management system, where the client’s own business rules can be applied. Alternatively, clients may use EHS’s interface.
Schlueter said, “It’s time we get back to the original purpose of UR, which is cost containment. As practiced today, UR is a very expensive and inefficient process. In effect, GIGI delivers cost containment to the practice of UR.”
Schlueter noted a CWCI study of almost a million requests that found 80% of medical requests submitted to UR tend to be reasonable and are certified. Unfortunately, the other 20% tend to be so far out of bounds that the industry has tolerated the inefficiencies of the existing process. Schlueter said, “The delays in treatment and substantial processing costs associated with today’s practice of UR are an increasing burden on a payer’s resources.”
Schlueter said, “GIGI’s guidance takes current medical pre-auth procedures to a whole new level. It will cut the significant waste from the system and expedite the delivery of necessary care to injured workers. It’s a game changer. It’s truly a cost containment program for one of the industry’s primary cost containment strategies.”
About Effective Health Systems:
EHS improves the quality of lives touched by the insurance industry. The BaseLine platform delivers workflow automation and intelligent augmentation systems that dramatically improve the effectiveness of claim professionals. BaseLine improves the work environment of claims’ professionals, as it eliminates waste and improves the profitability of the insurance company.
To learn more, check out Meet GIGI video at: https://www.ehsbaseline.com/meet-gigi-ur-tech
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