Appeals & Grievances – Drive Member and Provider Satisfaction
Drive member and provider satisfaction while enforcing compliance
The Centers for Medicare & Medicaid Services (CMS), as well as all other healthcare payers, require that every appeal and grievance is completely tracked, managed and documented to precise specifications. Getting it wrong can mean lengthy audits, corrective actions, and even stiff fines. Most health plans rely on complex manual processes to manage deadlines, expedite urgent appeals, document the appeal process and report internally and outside the organization.
The OnBase Appeals & Grievances (A&G) solution provides a complete approach to this compliance challenge. The solution leverages OnBase’s native case management capabilities, system connectors, letter generation and real-time dashboards to create a self-policing, CMS-compliant A&G process.
Systematically enforces CMS compliance
With appeals coming in from a variety of sources – via paper, fax, email, portals and the phone – it’s difficult to build compliance into processes. With OnBase A&G, every appeal is systematically tracked from receipt through determination, regardless of the source. The A&G solution also creates a complete audit trail that tracks every action with a date and time stamp, including who
viewed, edited, printed and routed the appeal.
Provides real-time process insight
Knowing appeal status at every step in the process is critical. The OnBase Appeals & Grievances solution provides dashboards that show real-time process details for inventory, productivity, work in process and more. Interactive reporting allows business users to quickly and simply report on everything that happens in the system, without having to make a call to the IT department.
Improves the A&G experience for all stakeholders
A goal of every health plan is a simple, clear and thorough process for internal and external stakeholders. Doctors, hospitals, and members, as well as the employees who are responsible for the appeals process, need to be positively engaged.