Transforming A&G Operations with Inovaare’s BPaaS Solution

Streamline Appeals and Grievances Processes, Enhance Operational Efficiency, and Reduce Operational Costs

• Automated and streamlined appeals and grievances (A&G) operations using Inovaare’s BPaaS solution, resulting in a significant reduction in the total cost of ownership and workforce resources.
• Centralized data management for efficient case handling and resolution.
• Improved compliance monitoring and audit readiness with built-in validation rules.

Quantifiable Results

The client is a leading managed vision care company based in Maryland, serving over 41 million members. They offer comprehensive eye health and vision care plans through well-known brands, focusing on providing accessible, high-quality, and effective vision care solutions.

Before partnering with Inovaare, the managed vision care company faced several significant challenges in its A&G operations:

• Uneven case volumes and manual workflows impacting efficiency and member experience.
• Difficulty meeting stringent turnaround time SLAs set by contracted Health Plans, necessitating enhanced staff expertise and collaboration.
• Lack of a modern technology stack to support industry best practices and ensure compliance.

The managed vision care company decided to adopt Inovaare’s BPaaS solution to enhance its A&G operations. Their specific goals included:

• Automate and streamline the A&G process to reduce manual effort and errors.
• Ensure data consistency and improve case handling efficiency with centralized data management.
• Enhance compliance and audit readiness with built-in validation rules and adherence to industry best practices.

After evaluating several technology solutions, the managed vision care company selected Inovaare’s BPaaS solution due to its robust automation capabilities, expert staff, and comprehensive data management features. The key aspects of the solution deployment include:

• Implementation of its AI-driven ‘Health Plan 3.0 Cloud Platform’ and A&G SaaS products, seamlessly integrating with the customer’s existing systems to streamline workflows and improve efficiency.
• Domain-expert staff with extensive health plan experience which seamlessly integrated with the customer’s operations.
• End-to-end data management, facilitating efficient communication and collaboration with external stakeholders.
• Round-the-clock support services ensured that the customer could meet the stringent turnaround time SLAs set by contracted Health Plans, avoiding penalties and maintaining strong relationships.
• Built-in compliance validation rules and industry best practices, ensuring adherence to CMS regulations and preparing the customer for audits.

The implementation of Inovaare’s BPaaS solution provided the managed vision care company with unprecedented levels of efficiency and accuracy in their A&G operations, leading to numerous benefits:

• Automated processes and streamlined workflows significantly reduced manual effort and errors, ensuring cases were resolved quickly and accurately.
• Built-in validation rules and detailed reporting enhanced compliance monitoring and audit readiness, enabling proactive management of regulatory risks.
• Automating and centralizing data management reduced the total cost of ownership by 47% and allowed the reallocation of 28% of workforce resources to higher-value tasks.
• Maintaining high accuracy ensured no cases were reopened due to errors, increasing trust and reliability in the dispute resolution process.
• Improved service quality and streamlined processes resulted in higher customer satisfaction scores.

The implementation of Inovaare’s BPaaS solution led to significant and measurable improvements for the managed vision care company:

• Achieved a 47% reduction in total cost of ownership (TCO).
• Achieved a 28% reduction in full-time employees, reallocating resources to higher-value tasks.
• Resolved 15,000 backlog cases, significantly improving case resolution times.
• Introduced an industry-leading Member/Provider Experience Platform, enhancing service delivery and client retention.
• Ensured compliance with regulations, avoiding financial penalties and regulatory fines.