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Navigate the Appeals & Grievance Process to Efficiently Command Audits and Reporting

PREPAREDNESS: THE BEST APPROACH

In California, we understand the value of preparation. The threat of unpredictable disasters results in the familiar admonition to be ready at all times because, when the inevitable strikes and alters our familiar routines, it leaves a storm of chaos in its wake.

Many healthcare organizations don’t proactively manage processes to ensure consistent compliance. Often, they rely on manual, time-consuming processes that result in a flurry of activity, torrents of inconsistent data and an inability to forecast predictable results.

Inovaare’s Appeals and Grievances (A&G) system—a cloud-based platform supported by a team with unparalleled healthcare compliance experience—provides the preparedness you need to weather any regulatory storm. Whether it comes from predictable events (routine reporting) or unpredictable audits (DMHC/DHCS), Inovaare has you covered.

SINGLE CLICK MEDI-CAL REPORTS

Inovaare protects you from the deluge of regulatory compliance workflows through automated reporting tools that ensure you are prepared at the click of a button. The days of long turnaround times for IT requests—and manual reviews to ensure accurate report submissions—are over.

MEDI-CAL ROUTINE REPORTING
  • Quarterly Grievance Report (APL 14-013)
  • Community-based Adult Services (CBAS)
  • Timely Access Report—Mental Health
  • Behavioral Health Treatment (BHT)
  • Annual Timely Access and Network Adequacy Grievance Report
KEY FEATURES
  • Accurate summaries—along with case details—support timely, compliant report submissions that please regulators and help avoid costly fines
  • Intuitive reporting tools can target select reports and date ranges
  • Predefined regulatory rules can be configured to ensure only the right cases are submitted
  • Real-time data ensures the flexibility to run reports that meet each due date

RAPID DHCS AND DMHC RESPONSE

The calm before a regulatory audit is the ideal time to collect, verify, audit and approve healthcare compliance data. But many health plans don’t have the luxury of maintaining their compliance systems on a daily basis; most often, they must reactively adjust to regulatory letters and notices.

So Inovaare designed its A&G reporting solutions to keep compliance teams prepared at all times.

A&G AUDIT LOGS

The scrutiny regulators apply to case information—scouring the data to find any form of non-compliance—makes Appeals and Grievances logs extremely important. And generating, auditing and approving A&G logs manually can be a painful, time-consuming process with a higher risk of invalid data. But an automated software solution addresses this problem.

Inovaare’s A&G logs empower health plans to proactively manage and respond to compliance requirements so they can stop operating reactively after regulators initiate an audit. The consistently accurate reports it generates will confirm a health plan is diligently working on behalf of its members.

A&G audit logs automate processes for the following:

  • APPEALS
    • Expedited
    • Standard
  • GRIEVANCES
    • Expedited
    • Standard
    • Exempt

It pays to be proactive. By scheduling routine provision of A&G logs from departments and delegates, they will become conditioned to operate in a state of preparedness. As a result, health plans will achieve more accurate results, timelysubmissions and the peace of mind knowing they are always prepared for the unexpected.

KEY FEATURES
  • Automatic population of requested DHCS fields and log generation with a single click
  • Predefined regulatory rules configured to ensure the right case is submitted to its corresponding DHCS or DMHC request

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