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Appeals & Grievances

Comprehensive Appeals & Grievances Platform Ensures Real-time Data Visibility

Healthcare reforms and evolving regulatory mandates can challenge effective Appeals & Grievances oversight and management. Quick turnaround of consistently accurate resolutions not only help ensure compliance with Centers for Medicare & Medicaid Services (CMS) regulations, but it also supports health plans’ objectives to:

  • Improve member satisfaction, leading to higher CMS Star Ratings
  • Reduce Notices of Non-compliance (NONCs)
  • Minimize Civil Monetary Penalties (CMPs)
For most health plans—despite industry best practices—relying on manual A&G processes is inefficient. Too often, compliance teams are burdened by:

  • Prolonged data-gathering processes
  • Unpredictable data integrity
  • Inconsistent compliance results
Without a turnkey compliance software platform, health plans and their first-tier, downstream and related entity (FDR) delegates will find it increasingly difficult to ensure efficient, consistently accurate regulatory requirements.

Inovaare’s Appeals & Grievances module provides both real-time data visibility and accurate A&G monitoring. This cloud-based software platform is configured to meet evolving regulatory changes and provide a seamless experience for health-plan teams as well as their valued plan members.


Key Benefits

  • Real-time A&G activity monitoring
  • Real-time tracking of unique appeals, grievances and CTM case files
  • Customer-defined configuration, allowing for rules and business adjustments to CMS regulation changes
  • Module core specifically designed for Medicare and Medicaid regulatory requirements
  • CMS Universes, created at the touch of a button
  • Highly complex business rules are easily supported
  • Flexible workflow-rule implementation, with multiple configuration options, require minimal effort

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