Optimization Starts Here
Appeals & Grievances
Appeals and grievances system with built-in compliance, workforce management and one-click universes
CMS universe management system for one-click universe generation and on-demand scrubbing of all universe tables for issue identification within minutes
Expand your solution to include QIO Appeals and Provider Dispute modules
Quality Review Services
Ensure cases are audit-ready at closure and be prepared for any internal or external audit
Accelerate onboarding of A&G professionals, achieve quicker return on talent and improve team productivity
Improve Member Experiences
Ensure Faster Issue Resolution
Achieve Continuous Audit Readiness
Drive Compliance to Mitigate Risk
Leverage Real-time Dashboards
Why the Largest Health Plans Trust Inovaare A&G Solutions
Effective oversight and management of Appeals & Grievances (A&G) can be challenging. Whether a Medicare, Medicaid, MMP, Marketplace or commercial healthcare provider, health plans must ensure their compliance procedures—as well as those of their delegated entities—are updated and ready for audit.
Inovaare’s industry-leading Appeals and Grievances software empowers compliance teams with end-to-end visibility of real-time data for accurate monitoring, better decision making and expedited resolutions. The platform also allows for Appeals and Grievances software configuration to meet rapidly evolving business and regulatory requirements.
Inovaare automates appeals and grievances processes, empowering A&G professionals to operate efficiently, with reduced reliance on IT support. A&G departments can now maintain continuous compliance while reaching the right resolution for each member. Health plans can also generate regulatory reports with the click of a button, while insightful executive dashboards empower better decision making.
- Highlight potential audit findings
- Expose potential risk
Support Better Star Ratings
- Contribute to faster turnaround times
- Enhance member experience
Elevate Operational Efficiency
- Streamline workflows
- Lower costs
- Flag potential non-compliance areas and risk in real time
- Draw attention to potential NONC issues
Simplify Regulatory Reporting
- Automate A&G processes
- Generate A&G universe tables and A&G Part C&D reporting with the click of a button
- Manage PTO
- Balance workloads
Configurable appeals and grievances processes for Medicare, Medicaid, Commercial, ACO, MMP, MSO and PACE lines of business
Real-time activity monitoring
Compliant appeals and grievances tracking
Complex business rules supported
Adjustable rules to keep pace with changing business requirements
Regulatory requirements designed into the core
Effective notification of compliance deadlines
Flexible workflow rules with multiple configuration options
Appeals & Grievances Software Packages
A&G Professional, A&G Enterprise and A&G Unlimited
Inovaare knows the world of Medicare, Medicaid, MMP, Marketplace and Commercial health plans from decades of hands-on A&G department oversight. This expertise resulted in an Appeals and Grievances software platform rich in features and it’s unparalleled in the market.
Inovaare created three Appeals and Grievances software packages to meet any health plan’s unique requirements: A&G Professional, A&G Enterprise and A&G Unlimited. For many health plans, A&G Professional is an out-of-the-box solution that can be implemented in as little as 30 business days to lower operating costs and improve member experience. However, for payers who require more complex processes, A&G Enterprise can be customized to address each requirement. And A&G Unlimited accelerates ongoing enhancements after Go Live, resulting in an even greater ROI.
Personalized Home Pages by Role
- Configure the landing page and view to optimize productivity
- Auto-prioritize cases and tasks to ensure the right issues are being worked first by agents
- Receive the most urgent case alerts to help ensure compliance
Dynamic Case Management
- Connect people
- Create a 360-degree view of the member
- Gain end-to-end visibility for efficient issue resolution
- Reduce non-compliance
- Help ensure cases are closed properly
- Automate outreach emails or written notifications as required
- Preconfigured workflows embedded right out of the box to drive compliance
- User-defined role approval for 14-day extensions
- Robust AOR and WOL repository
- Set conditions for letters and only make them available when appropriate
- Automate approval and publishing processes
- Help ensure letters meet timeliness requirements
Dashboard and Analytics
- Optimize workflows, address urgent issues, and drive operational as well as compliance efficiencies
- Configure customized KPIs within a configurable platform
- Analyze intuitive dashboards
Implement Dynamic case management workflows
Provider Dispute Resolution
Health plans must submit annual reports regarding the number, type and provider claim payment-dispute summaries. They are also required to describe the resolutions including terms and timeliness and explain how they are addressing trends or patterns in disputes.
With Provider Dispute Resolution (PDR), health plans can:
Ensure 360-degree view of Decision processes
The Quality Improvement Organization (QIO) Program, one of the largest federal programs dedicated to improving health quality for Medicare beneficiaries, is an integral part of the U.S. Department of Health and Human Services’ National Quality Strategy for providing better care and outcomes at lower costs. CMS relies on QIOs to improve the quality of healthcare for all Medicare beneficiaries.
Inovaare’s QIO Appeals solution helps:
Take a lighthearted tour within a fictitious health plan as they confront common scenarios when evaluating vendor products before experiencing Inovaare’s industry-leading Appeals & Grievances solution.
A&G OVERVIEW: VIDEO
Do you want to build a world-class Appeals and Grievances department? Explore five keys to success and seven pillars of a complete A&G system.
A&G PRO 30
Inovaare standardized its A&G solution so implementation can be achieved within 30 business days. Ideal for small- to medium-sized health plans.
Discover how to simplify A&G processes through automation during this 40-minute webinar: How to Simplify CMS Appeals & Grievances Reporting.
Want to know more about Medicare appeals best practices? How Do You Like Them Appeals explains.
Need a customized A&G solution? Inovaare empowers compliance teams with visibility of real-time data for accurate monitoring, better decision making and expedited resolutions.