Appeals & Grievances Automation for a Leading Health Plan
The Health Plan is a managed care organization, serving nearly 25,000 members. With a view to enhancing member experience and ensuring compliance, the Health Plan decided to streamline its document-intensive Appeals & Grievances process.
Barriers to Growth
The Health Plan’s customer service department received various Medicaid & Medicare appeals and grievances cases from multiple channels. Due to the non-standardization of the process, the department had to rely on multiple systems and collaborate with different departments, namely claims, pharmacy, provider relations. Hence, to address these day-to-day operational challenges, the Health Plan decided to streamline the process.
The Health Plan expedited its resolution process and maximized overall efficiencies by a significant margin. Further, with extensive audit logs and reporting capabilities of the implemented solution, the Health Plan ensured compliance by 98%. To know more about the Plan’s business requirements and how Newgen helped, download the complete case study.