Open the claim
Capture eligibility, benefit, provider, diagnosis and service documentation.
International claims administration
Accuracy, cost control and accountability in every claim.
GRH connects the administrative and clinical record so payer teams can understand what happened, why it was covered and where cost was controlled.
Lifecycle supportFrom intake through resolution
Clinical contextCase activity connected to the claim
Cost controlsNetwork, review and negotiation levers
Payer reportingClear records for operational decisions
A disciplined workflow
A clear path from notification to resolution.
Each stage has an owner, a defined control point and documentation that follows the claim.
Validate the record
Check completeness, coding, authorization, duplication and policy alignment.
Apply cost levers
Use contracted access, bill review and direct negotiation where appropriate.
Document the outcome
Coordinate disposition, maintain the audit trail and return payer reporting.
Claims capabilities
Administrative precision with clinical context.
The claim does not sit apart from the member’s care journey. Our operating model keeps the two connected.
Eligibility & benefits
Align member status, plan requirements and the documented episode of care.
Bill & document intake
Organize provider bills, clinical records, authorizations and supporting files.
Adjudication support
Review coverage, coding, policy rules, exclusions and prior case activity.
Medical bill review
Identify inconsistencies, duplicate charges and opportunities for cost control.
Payment coordination
Support approved-amount communication, provider follow-up and resolution records.
Quality & reporting
Maintain traceable decisions and structured data for payer operations and analysis.
Complex and high-cost claims
Bring clinical management into the financial workflow early.
For catastrophic, prolonged or complex cases, administrative review alone is not enough. GRH coordinates clinical, provider and payer teams around the same plan.
- Early identification of high-cost and prolonged cases
- Medical necessity and utilization review support
- Site-of-care and provider-direction options
- Ongoing reserve and case-status visibility
Reporting designed for action
Claims data should help teams improve the next decision—not simply document the last one.
- Claim and case status views
- Cost and utilization patterns
- Network and negotiation activity
- Exception and escalation tracking
- Program-level trend reporting
Common questions
Fit the workflow to your plan.
GRH can support a defined part of the claim lifecycle or coordinate the complete international workflow.
Can GRH work with our existing claims team?
Yes. The operating model can be scoped around specific geographies, claim types, high-cost thresholds or defined administrative functions.
How are clinical and claim records connected?
Case coordination, authorizations, provider communication and supporting clinical documentation are maintained as part of the same controlled workflow.
Can reporting be adapted to payer needs?
Program reporting can be aligned to the operational, financial and utilization views agreed during implementation.
Do you support international provider bills?
GRH is designed for cross-border workflows and coordinates documentation and provider communication across markets and currencies.
Build a claims workflow around your book of business.
Start with your current process, target markets and most difficult claim types.