Case Study: Appeals & Grievances Automation for a Leading Health Plan

CASE STUDY

Appeals & Grievances Automation for a Leading Health Plan

About the 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 was receiving 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 various other departments such as claims, pharmacy, provider relations. In order to address these operational challenges, the Health Plan decided to streamline the process.

Implementation Outcomes

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, Health Plan could ensure compliance by 98%. To know the more about the Plan’s needs and how Newgen helped, download the complete case study.

 

 

 

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