• 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
    Data Sheet
    Medicare Stars
  • 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)
    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
  • WHAT MAKES CAG BETTER
    CAG is purpose built specifically for the needs of A&G teams, providing an end-to-end (one-stop) solution for A&G intake, triage, investigation, resolution, management, and reporting.
    Business & Compliance Rules
    Operational Guidance
    Business Rules Validation
    Compliance Rules Validation
    Configurable Work Distribution and Prioritization
    Integration & Collaboration
    360° Case View w/ Integration Accelerator Framework
    Cloud Collaboration Suite
    Rapid Investigation
    Quality Management
    Automation
    Work Distribution and Prioritization
    Letter and Report Generation
    Pending and Follow-Ups
    Alerts and Notifications
  • Get A Glimpse of CAG
    Watch the Explainer
    Dramatically improve the efficiency and effectiveness of your operations with CAG.
    BOOK A DEMO
  • Get in Touch
    Inspire Innovations - CAG Group
    85 Broad St. 29th Floor, NYC
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