OUT-PATIENT BENEFITS MANAGEMENT (OBM)
Out-Patient Benefits Management (OBM)
GlobeMed’s Out-Patient Benefits Management (OBM) solution combines a state-of-the-art IT platform, industry know-how and best practices to effectively manage payers’ out-patient benefits plans and improve members’ experience, while controlling costs.
GlobeMed’s Out-Patient Benefits Management (OBM) solution combines a state-of-the-art IT platform, industry know-how and best practices to effectively manage payers’ out-patient benefits plans and improve members’ experience, while controlling costs. Our OBM can be integrated within GlobeMed’s full TPA services or offered as a standalone solution for risk carriers.
Out-Patient care covers a wide range of medical services and procedures conducted on an outpatient basis in clinics, diagnostic centers, dental clinics, optical centers, etc. Out-Patient procedures include lab tests, radiology, physiotherapy, doctor consultations, optical and dental services and much more.
The key features of the OBM are:
• Benefit Design Options
• Members' Administration
• Network Management
• Online Eligibility/Automated Prior Authorization/Claims Submission
• Advanced Expert System
• Analytics, Business Intelligence & Reporting
Furthermore, GlobeMed’s expert system, ARC, checks out-patient claims against the automated medical rules and coding edits to identify any potential problem while rendering ambulatory services. It is based on well renowned databases and dictionaries including a standard medical dictionary based on medical necessity rules, coding edits dictionary and a medico-administrative dictionary for the rules related to policy benefits and restrictions.
