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Healthcare Compliance Blog

Optimize your Appeals and Grievances Process

When it comes to appeals and grievances, most healthcare organizations struggle to improve compliance, productivity, visibility, and ratings while lowering penalties.

Steps to optimize your Appeals and Grievances process:

  1. Make reaching out to complain a child’s play: Complaints are nothing but valuable data about what you could do better to improve your processes, products, customer experience and ultimately bottom lines. Easy of filing a complaint has a direct and positive impact on member and provider satisfaction. So focus on making the process easy and inexpensive.
  2. Establish your cost-per-complaint: It is critical that you establish your cost-per-complaint before you settle for a solution that tracks every appeal or grievance and then provides analytics and actionable insights based real-time data.
  3. Reduce your cost-per-complaint: You can reduce your cost-per-complaint by automating the process end-to-end and across channels. Rely on an easy to use technology that requires minimal training and on-boarding of staff to be able to deliver positive outcomes.
  4. Build a robust complaining culture: Develop a transparent, automated solution that closes a complaint within hours and sends automated alerts and status reports to the complainant. Recognize good complaining trends and set benchmarks that reflect in improved operational efficiencies. Develop, deploy and modify automated appeals and grievances processes for rapid time to value and continuous improvement.

Have a question? Please contact Brenda Wade or Gabe Viola

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