Member Experience / A&G Management
Appeals & Grievances Management for Health Plans
Health plans need more than just compliance; they need speed, savings, and better member outcomes. Our comprehensive A&G solution automates case intake, streamlines workflows, ensures regulatory compliance, and delivers faster, smarter resolutions.
What we solve
What’s broken in A&G
Every case matters. One delay or error can lead to audit findings, penalties, and lost Star Ratings. A&G leaders operate under constant scrutiny and have a direct impact on compliance, reputation, and revenue. Yet many are stuck with disconnected tools and reactive processes. They deserve better.
Fragmented data
Siloed systems turn audit prep into a scramble, slowing down compliance, visibility, and decisions.
Disconnected systems
Spreadsheets, SharePoint, and homegrown tools lack scale, compliance alignment, and long-term viability.
Poor member experience
Delays, unresolved grievances, and weak follow-ups hurt satisfaction, even when care quality is high.
IT is a bottleneck
A&G teams depend on IT for reports, rule changes, and fixes, limiting autonomy and slowing response times.
How we solve
Turn your A&G processes into a competitive advantage
Unified case view
We centralize appeal and grievance data across delegates, channels, and systems, giving teams a single source of truth with real-time access and analytics.
End-to-end A&G platform
We replace patchwork tools with an end-to-end platform built for A&G, from intake to audit, with compliance logic, templates, and workflows built in.
Member-centric approach
Our solution tracks case progress, automates follow-ups, and ensures timely responses, turning complaint resolution into a trust-building opportunity.
Low-code / no-code autonomy
With low-code/no-code controls, role-based access, and built-in configuration, A&G teams can manage timelines, rules, and reports, on their own terms.
Why health plans trust Inovaare
Healthcare native. Payer trusted.
We’ve been in your shoes, and we understand the pressure of A&G because our experts have lived it. That’s why our solution isn’t just another case management tool, but purpose-built for healthcare payers. It aligns with real operations and regulatory needs, delivering audit readiness, real-time visibility, and no-code control with speed and security.
Purpose-built for payers
Aligns with the regulatory and operational realities of the A&G function.
Compliance-driven
Built in rules and checks enforce compliance at every point
Seamless integrations
API-first approach for connected, efficient Workflows
Fast implementation
Your A&G team can go live in weeks, delivering immediate improvements and a clear ROI
HITRUST certified
We meet the highest security and enterprise-grande compliance standards.
Empowers business users
Low-code / no-code tools for full control and on-the-go configurations.
Value we bring
Built for payers. Powered by automation.
End-to-end compliance
Prebuilt rules, real-time checks, and auto-generated universes keep you audit-ready, every day, not just deadline day.
Lower cost to serve
AI workflows and self-service tools cut turnaround time and manual effort, freeing teams to focus on impact.
Full visibility and control
Dashboards, rules, and reports are owned by business users, so operations move faster, with zero dependence on IT.
Member-first focus
Automated updates, accurate resolutions, and faster follow-ups improve satisfaction and protect Star Ratings.
Key features
Empower your A&G team to deliver outcomes
Move fast, stay compliant, and scale confidently with a healthcare-centric platform that combines regulatory intelligence,
AI-powered automation and user-controlled configuration to eliminate friction from A&G workflows.
One-click report generation
Instantly generates compliant reports and universes, eliminating errors and delays.
Workforce management
Tool to track and assign cases, and balance workload and capacity in real time.
Letter management
Auto-generates and tracks member and provider letters with version control.
Centralized dashboards
Real-time visibility across teams, cases, and performance metrics.
Global communication hub
Central hub for communication with internal teams and external vendors.
Real-time audit logs
Automatically logs every action taken on and every task assigned for a case.
Task tracker
Tracks key due dates, triggers alerts, and helps avoid NMPs for regulatory deadlines.
AI Agent–driven case intake
Autonomous AI agents classify, assign, and initiate cases automatically.
Engineered for Compliance. Designed for Efficiency.
Power your A&G operations with integrated tools
A&G management
Effortlessly manage appeals and grievances! Automate workflows, reduce manual effort, and ensure timely resolutions. Improve compliance and operational efficiency while enhancing member satisfaction with seamless, accurate, and real-time tracking of appeals and grievances. ×
Member journey dashboard
Gain Comprehensive Insights into Member Journeys! Track every touchpoint and interaction across the member lifecycle, providing a holistic view that drives better decision-making. Identify trends, improve service delivery, and increase member satisfaction with detailed, actionable insights. ×
PQI & QIO
Ensure the highest standards of quality care with our Potential Quality Issue (PQI) & Quality Information Organization (QIO) solutions. Automate quality improvement processes, monitor performance metrics, and comply with regulatory standards. Drive continuous improvement in care delivery and outcomes, and maintain excellence in healthcare services. ×
Data scrubber suite
Our Data Scrubber Suite helps you maintain clean, accurate data for all your reporting needs. Automate data scrubbing processes to identify and correct errors, ensuring compliance with regulatory requirements. Improve data integrity, reduce risks, and enhance decision-making with reliable data. ×
A&G Universe Generator & Scrubber
From manual scrubbing to instant universe accuracy
A&G advanced analytics
See the patterns. Prevent the problems.
IRE package manager
Automate IRE submissions without the risk
AI that works for your A&G team
AI that doesn’t just automate, it elevates
Our Agentic AI-powered case management and specialized AI agents streamline intake, accelerate triage, automate compliance checks, and flag risks in real time, boosting speed, accuracy, and member satisfaction with zero guesswork.
Success story
Outcomes that matter in A&G
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Equip your health plans with the tools to proactively identify, manage, and resolve quality issues before they escalate.
FAQs
Have questions? We have answers.
Regulatory Compliance
Inovaare’s platform is built with real-time compliance tracking and pre-configured regulatory logic, enabling health plans to automate documentation, maintain audit-ready records, and avoid non-compliance penalties. It ensures every process—from intake to resolution—adheres to CMS guidelines.
Our cloud-based platform includes continuous State and Federal rule updates and audit templates, so health plans never fall behind on regulatory compliance. These updates are applied automatically, reducing the need for manual configuration or IT support.
Pricing & Implementation
Our pricing is flexible and aligned with your operational model. We offer both user-based and case volume-based pricing tiers, so you only pay for what you use, whether you’re a small plan or a national health insurer.
Yes. Our pricing includes implementation, onboarding, and ongoing support. No hidden fees. We work with your team to configure the solution to your workflows, compliance needs, and reporting requirements from day one.
Most implementations are completed within weeks, not months. Our prebuilt templates and rapid deployment framework minimize disruption and deliver faster time-to-value.
We offer end-to-end onboarding, configuration assistance, user training, and ongoing support. Our team ensures smooth adoption and continuous optimization tailored to your compliance needs.
Operations
Inovaare reduces the cost to serve by automating labor-intensive tasks, minimizing audit penalties, and improving staff productivity. Most clients experience up to a 67% reduction in compliance-related expenses within the first year, making it a high-ROI investment for financial leaders focused on operational savings.
No. The platform is built to empower business users through no-code configuration. IT involvement is minimal beyond initial setup, freeing up technical resources for strategic priorities.
Technology
Yes. Inovaare’s open API architecture ensures seamless integration with EHRs, claims systems, and core platforms, enabling unified data access across appeals, grievances, compliance, and audit workflows.
Absolutely. Inovaare is a modern, cloud-native platform built to scale with your health plan’s growth. It supports multi-region backups, continuous monitoring, and seamless updates.
Yes. Our self-service platform empowers users to configure rules, routing, templates, and workflows without developer support, reducing IT dependency and increasing agility.
Inovaare follows HIPAA and HITRUST-certified protocols for secure API-based integrations. All data in transit and at rest is encrypted, ensuring compliance with healthcare data security standards.
Inovaare is hosted on a secure, scalable cloud-native infrastructure with multi-region backup, automated updates, and 24/7 monitoring. It’s built for performance, reliability, and compliance with industry-leading standards.
Absolutely. Our AI agents are fully configurable. You can define rules, triggers, escalation paths, and compliance logic based on your internal workflows and regulatory requirements. The system adapts to how your plan operates—not the other way around.
Yes, our A&G solution is built on a modern platform that fully supports Agentic AI. This means your workflows aren’t just automated—they’re intelligent. Our AI agents can take actions independently across intake, review, resolution, and reporting. You don’t need to be an AI expert to benefit. Everything is pre-configured, secure, and designed to work within your compliance framework, giving your team more time to focus on high-priority work, not repetitive tasks.
No, our solution is cloud-native by design. This allows for faster deployment, better scalability, built-in security, and seamless updates. It also means you get continuous improvements and the latest compliance logic—without the burden of managing infrastructure.
Our platform is continuously updated to support the latest advancements, including AI, automation, and regulatory tech. It’s built on a modern, extensible architecture—so new features, smarter agents, and compliance updates are added seamlessly, without disrupting your operations. You get long-term value without needing to rebuild or re-implement.