Appeals & Grievances
When it comes to appeals and grievances, healthcare organizations are struggling to improve compliance, increase productivity, raise quality scores, minimize penalties, enhance reporting, and boost member and provider satisfaction.
Our NCQA Accredited services deliver proven solutions to improve compliance and boost quality scores, such as 5-star ratings. By leveraging the power and flexibility of our solutions, your organization can simplify the appeals and grievance process. Your team will be able to view, enter and update appeals and grievance cases as well as export logs in PDF and Excel formats. Our reporting feature includes all fields of documentation and can be configured as needed to support existing and new requirements. Our team reports data on a weekly and monthly basis which includes but not limited to: inventory received, timeliness of processing, amount of upheld or overturn decisions, amount of cases dismissed, and amount of pending cases.
Your team will be able to:
- Enroll and reconcile members efficiently and accurately
- Receive the highest STAR ratings for quality care
- Track and report on critical quality and compliance measures
- Execute successful audits with CMS and AHCA