Health insurers easily manage CMS appeals & grievances

Hit deadlines, expedite urgent appeals, document the appeal process and report internally and outside the organisation to maintain compliance and increase customer service with the OnBase Appeals & Grievances (A&G) solution.

Video Transcription

Facing pressure to meet state and federal regulators ever-evolving mandates, you need to make sure you're tracking and documenting appeals and grievances correctly. Especially when getting it wrong can mean lengthy audits, stiff fines and unhappy members and providers. But with appeals and grievances cases coming in from a variety of sources – from web portals and emails to faxes, phone calls and hard copies – the process of managing appeals and grievances is not an easy one.

OnBase offers health plans an end-to-end solution

From the initial capture of case documents and data through determination, the appeals and grievances solution also creates a complete, fully auditable trail of all interactions so that you know who viewed, edited, printed and routed the appeal or grievance and when. Automated notification letters with pre-approved language take the guesswork out of document creation.

OnBase stores all documents and notes associated with cases in a secure repository for easy:

  • Retrieval
  • Tracking
  • Managing independent review

Interactive reporting capabilities allow business users to quickly report on everything that happens without calling the IT Department. Dashboards provide real-time information so your internal auditors, plan managers and executives are able to monitor inventory, productivity, work in progress and other process details.

With its 360-degree view, OnBase offers health plans a simple, clear and thorough appeals and grievances process for worry-free compliance and improved service for members and providers alike.

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