GIGI is the most innovative and disruptive advance in the medical authorization triage process in over a decade.
In January of 2009, we launched an application called Smart-UR. It was in response to the growing issue of rapidly increasing costs of medical management. Smart-UR was a triage application that integrated an experience-based set of recommendations created by several medical providers. We billed it as a cost-containment program for your cost-containment program. It was an immediate market success receiving a market adoption rate of 18% - 20% of the workers' comp payer market in its first two years.
Around 2010, the EBG companies introduced a decision support tool for triaging medical requests for quick payment. Their decision-support devices identified a set of CPT codes that were high-frequency and low-cost treatments. Such requests were recommended for auto-payment to streamline the UR process based on the assumption that the low cost of the procedures as compared to the high cost of UR and the associated disputes. We were among the first technologies to adopt these new products and integrate them into the Smart-UR application.
The crosswalks did help to contain costs, but their basis is more accounting sizzle than meaty science.
Subsequently, in 2020, EHS decided to push the envelope and create a science-based medical triage tool based on the evidence of actual UR decisions. In conjunction with a noted data scientist, Dr. Laura Gartner, MD, MPH, Ph.D., FACPM, we developed a predictive algorithm, supported by machine learning, designed to predict the likelihood of a medical request being certified by a URO. The algorithm reviewed over 800,000 UR determinations, incorporated multiple demographic and claim variables, and will deliver a triage decision on all types of medical requests, including CPT, HCPCS, and Pharmacy (not just CPT codes). Importantly, cost factors were not among the variables.
The WOW factor is that GIGI has proven to be 92.5% accurate in its prediction of CPTs, HCPCSs, and Pharmacy certification.
Further, we identified the false positives by critical types. Subsequently, clients can target and control for them via simple business rules.
Significantly, as an optional feature to assist in making a triage determination, GIGI can also report the locality-specific Medicare Fee Schedule pricing data on specific treatments and services for various CPT and DME/POS products and services.
Without question, GIGI is the most innovative and disruptive advance in the medical authorization process in over a decade. GIGI can fully automate your triage process while enhancing your ability to target medical requests where the investment in high-level UR is justified. Thus, you can reallocate your professional team to higher-value tasks.
GIGI is a SaaS application that can be integrated into any software capable of accessing SaaS technologies.
I'm Don Adams, the CRO with EHS.
GIGI is quick and inexpensive to implement. Importantly, GIGI can become a visible showcase of your company's commitment to advanced technology. GIGI's ability to deliver immediate efficiencies and cost savings to your clients & prospects will be instantly evident. GIGI is the kind of technology that can swing a decision with today's business leaders when they are deciding where to place their trust and contracts. Face it, technology is the new table stakes in this game. GIGI is cutting-edge technology that allows you to offer your clients/prospects tangible savings and better service than anything else out there. It can get you noticed.
Drop me an email. We can make this happen quickly for you.