• INSPIRE INNOVATIONS
    Case-Management
    Compliant Appeals & Grievances (CAG)
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  • Compliant Appeals & Grievances
    Breakdown the complexities and inefficiencies of handling appeals and grievances
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  • ACHIEVE AN ENTIRE TRANSFORMATION WITH CAG
    A SAAS THAT PROVIDES AN ENTIRE SUITE OF A&G TECHNOLOGY

    Companies focusing on customer centricity, efficient process, effective use of data, and partner enablement consistently outperform their competitors while turning their customers and partners into promoters

  • Workflow-Driven, Intelligent A&G Case Management
    With the ever-increasing challenges of business rules, operational procedures, service level agreements, regulatory requirements, unpredictable volumes, error-prone procedural issues and medical management, handling appeals and grievances (A&G) is an intricate, complex and manually intensive process.

    Compliant A&G breaks down these complexities with an automated approach that allows you to efficiently address member and provider complaints while gathering insightful, evidence-based data to improve quality, increase performance and reduce risk.
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    1 REDUCE MANUAL EFFORTS AND COSTS

    Automate the tedious manual efforts associated with managing A&G cases.

    2 SIMPLIFY YOUR OPERATION

    Guide your teams with configurable rules engines, dynamic wizard-driven forms and interfaces, and on-screen operating guidance

    3 IMPROVE STAR RATINGS, AVOID PENALTIES

    Ensure compliance with Medicare and Medicaid rules engines enforcing case rules

    4 IMPROVE OUTCOMES & QUALITY

    Augment knowledge workers by giving them the data they need when they need and enforce service level compliance

    5 GAIN ACTIVE & HISTORICAL INSIGHTS

    Search and explore vast amounts of constantly shifting A&G data - all of it - A&G Case, Enrollment, Plan, Benefit, Claim, and Authorization

  • Software & Compliance as a Service (SCaaS)
    100%
    The percentage of time the service has been up (Zero-Downtime)
    0
    The number of security breaches
    $0
    The amount of non-compliance penalties paid by our customers
  • SOME OF OUR CLIENTS INCLUDE
  • Need to increase your Star ratings and avoid penalties?
    Automate compliance and boost quality scores with industry leading Medicare and Medicaid Compliance Rules Engines. Additionally, stay on top of increasing regulatory requirements with our Compliance as a Service.
    Medicare and Medicaid Rules Engines / Compliance Monitoring Service
  • Want to improve outcomes as well as quality?
    View your vast amounts of constantly shifting G&A data - all of it. You're not constrained by preconceived notions of how data should be related, but can finally understand how it truly is related. Analyze, reveal, and act.
    With built-in Qlik Analytical Dashboards Specific to G&A
  • Want to improve efficiency and reduce costs?
    Automate the tedious administrative tasks associated with managing grievances and appeals, such as: Data Entry, Data Aggregation, Letter Generation, Pending for Information, Follow-Ups, Notifications, and Alerts.
    Process Automation Toolkit
  • Get A Glimpse of CAG
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    Dramatically improve the efficiency and effectiveness of your operations with CAG.
  • Get in Touch
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