Complaints, Appeals and Grievances
Implement a real-time workflow including intake and distribution of highly sensitive Complaints, Appeals & Griveances. Provide configurable workflow templates for rapid data entry, automated validation and standardized data collection. Use standard productivity, activity, and operational reports for managing the work. Utilize complex executive decision management reports to fully comprehend the work effort.
The Softheon Business Connector Complaints, Appeals & Grievances (CAG) solution gives the healthcare payers all the tools necessary to handle the CAG process. CAG solution integrates easily with a variety of third-party applications, an advantage that similar systems do not offer.
Additional benefits of the Softheon Business Connector Complaints, Appeals & Grievances solution include:
- Give your organization the ability to effectively address a myriad of business problems using one platform, with the opportunity to integrate information across business services if desired
- Enhance and streamlines CAG case processing, using business rules that effectively identify and differentiate categories such as regular, expedited, clinical, appeals, grievances, and reconsiderations
- Enable work to be distributed and performed in a consistent manner while providing support for the collection of data and statistics for operational and predictive modeling scenarios
- Provide faster access to needed information, which means improved response time and Service Level Agreement (SLA) performance metrics, leading to improved member and provider retention
- Save costs of pulling data together from disparate systems for audits, governmental, and professional organization reporting
- Provide information for timely decision making related to CAG cases while affording a platform for other enterprise initiatives