In the era of consumer driven healthcare, you must manage appeals and grievances in a seamless manner to gain a competitive edge. Providing quick and accurate resolutions will enable you to deliver superior member experience, improve star ratings, prevent legal & financial penalties, and most importantly ensure member satisfaction.
We offer you a business configurable process automation and improvement framework that allows timely resolution of appeals & grievances received in any form – email, paper, mail, customer service, web portal, walk-ins, fax, electronic documents etc. The smart rules driven engine prioritizes all transactions for automated routing, ensuring resource optimization, and reduced turnaround times. It guarantees enhanced customer satisfaction, through a robust correspondence management system that automatically initiates appropriate communications at various stages of the process.
Brochure: Complaints, Appeals and Grievances
Read the solution sheet to understand how you can automate your day-to-day operations at all levels of administrative hierarchy and deliver timely resolution of cases.
Get a single-door entry for all your member complaints, coming from multiple channels. Integrate directly with various sources, such as email, portal, fax, etc.
360-Degree Case View
Get a holistic view of all relevant cases. Access previous case history of members as per needs and make well-informed decisions
Facilitate user or user group to auto-assign cases in all workflows per business role to work in an organized manner
Utilize pre-configured user tasks and dynamic case management capabilities to take prompt actions for each member complaint. Discard, archive duplicate cases and classify the valid ones for further processing
Trigger letters, such as acknowledgment, resolution, and appointment of representatives in a member’s preferred language
Audit Trail Documentation
Collaborate case artefacts and information to prepare case summary documents. Provide data packages for the historical and archived cases for CMS auditing
Dashboard for CMS Reports
Provide pre-configured dashboard with in-house reports, metrics for operations and reports defined as per CMS guidelines. Maintain complete visibility of all requests data by leveraging faster-searching capabilities
Reduce manual hand-offs by automating processes. Minimize scope for unnecessary delays or errors
Leverage extensive audit features and continually monitor case milestones and resolution timelines
Enhanced Member Engagement
Access information in real-time and reduce overall processing times. Witness faster decision making and better member engagement
Save member information in encrypted format. Assign rights-based access for further processing of member cases, and define roles and responsibilities of your business users in a streamlined manner
Witness better routing with provisions to manage escalations and case exceptions via workflow and auto-prioritization of standard and expedited cases
Leverage comprehensive dashboard to manage cases conveniently. Keep business managers apprised of ongoing status of member cases in order to enhance overall visibility in your organization