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 and appeals while gathering insightful, evidence-based data to improve quality, increase performance and reduce risk.
1 REDUCE MANUAL EFFORTS AND COSTS
Automate the tedious manual efforts associated with managing A&G cases and augment decision making.
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, timeliness, and quality 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