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Complaint Tracking Module

Comprehensively Manage and Track Complaints

In the face of ever-increasing customer complaints—combined with stringent CMS regulation requirements regarding the tracking and management of those complaints—health plans must efficiently identify, report, manage and resolve complaints. Mismanaged complaint management compounds issues, over time, resulting in a major operational and reputational damage.

The Centers for Medicare and Medicaid Services (CMS) communicates complaints from beneficiaries and providers via a Complaint Tracking Module (CTM) to the Medicare Part C or D Sponsor. Regulatory requirements strictly enforce the importance of ensuring:

  • Quick acknowledgement of all complaints
  • Ethical investigating and timely complaint resolution
  • High process visibility from CMS
Inovaare’s Complaint Tracking module enables health plans to:

  • Comprehensively manage end-to-end complaint process
  • Ensure efficient complaint resolution
  • Incorporate evolving changes in CMS mandates and rules
Complaint Tracking even enables compliance teams to download cases from the CMS Health Plan Management System (HPMS) and systematically upload required HPMS files, saving health plans significant time and effort.

Inovaare CTM

Key Benefits

  • Generate CMS-required correspondence in real time
  • Track cases at each stage of the process to ensure complaint resolution
  • Improve complaint response practices
  • Initiate email notification and routing assignments
  • Attach documents to member records
  • Receive alerts when an item is due as well as past-due notifications
  • Customize supervisory reminders

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