Comprehensive Appeals & Grievances Platform Leverages Real-time Data
Effective oversight and management of Appeals & Grievances (A&G) can be challenging. Whether a Medicare, Medicaid, 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.
Despite recent innovations, many health plans rely on manual, time-consuming A&G processes that result in data integrity issues and unpredictable results. Quick turnaround of consistently compliant resolutions is not only required to satisfy regulatory agencies, it also provides a competitive edge to health plans.
Inovaare’s comprehensive A&G solution empowers compliance teams with visibility of real-time data for accurate monitoring, better decision making and expedited resolutions. The cloud-based platform allows for A&G software configuration to meet rapidly evolving business and regulatory requirements while providing a seamless experience for both health plan users as well as plan members.
KEY BENEFITS
- Configurable appeals and grievances processes for Medicare, Medicaid, Commercial, ACO, MMP, MSO and PACE lines of business
- Real-time activity monitoring
- Unique appeals and grievances tracking
- Adjustable rules to keep pace with changing business requirements
- Regulatory requirements designed into the core
- Effective adherence to compliance deadlines
- Complex business rules supported
- Flexible workflow rules—with multiple configuration options—can be supported easily