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Appeals & Grievances

Comprehensive Appeals & Grievances Platform that Ensures Visibility of Real-time Data

Shifts in healthcare through healthcare reforms and regulatory mandates can challenge the effective oversight and management of Appeals & Grievances. Quick turnaround and consistent resolutions not only ensure compliance with CMS but also provides a competitive edge to health plans. These best practices lead to improved STAR ratings, reductions in NONC’s (Notice of Non-Compliance), minimal or reduced CMPs (Civil Monetary Penalties) and most importantly, increased member satisfaction.

Despite these best practices, most health plans are challenged with relying on A&G processes that are manual, time-consuming, and ineffective resulting in unpredictability and inconsistency in data integrity. Without a comprehensive software platform, health plans and their affiliates will increasingly encounter obstacles in meeting regulatory requirements in a timely and accurate manner.

Inovaare’s Appeals & Grievance’s solution provides both the visibility of real-time data and monitors accuracy. Our software platform is configured to meet regulatory changes and provide a seamless experience for both the health plan users as well as plan members.

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Key Benefits

  • Real-time monitoring of activity by management
  • Allows for tracking of unique appeals, grievances and CTM case files
  • Highly Configurable, allowing for clients to adjust rules as the business changes
  • Designed with Regulatory Requirements at the core (Medicare, Medicaid, and others)
  • Creates CMS Universes at the touch of a button
  • Enables plans to more effectively Adhere to compliance deadlines and requirements
  • Supports highly complex business rules
  • Flexible workflow rules with multiple configuration options can be supported with minimal efforts

Have a question? Contact us at info@inovaare.com