Compliant Appeals & Grievances

Breakdown the complexities and inefficiencies of handling appeals and grievances

Data Sheet

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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 and appeals 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 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

SOFTWARE (& COMPLIANCE) as a SERVICE

100%

The percentage of time the service has been up (Zero-Downtime)

The number of security breaches

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

WHAT MAKES CAG BETTER?

CAG's first version was built almost 10-years ago and has been continuously enhanced and improved ever since; Focused solely on the needs of A&G teams, providing an end-to-end (one-stop) solution for A&G intake, triage, investigation, resolution, management, and reporting. CAG is currently on its seventh iteration and built using today's latest technology of Angular and microservices.

Business & Compliance Rules