Breakdown the complexities and inefficiencies of handling appeals and grievances
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WHERE ARE YOU IN YOUR TRANSFORMATION JOURNEY?
WE DRIVE GROWTH THROUGH EFFICIENT AND EFFECTIVE SYSTEMATIC MEANS
Companies focusing on customer centricity, efficient process, effective use of data, and partner enablement consistently outperform their competitors and turn their customers into promoters
Workflow-Driven, Intelligent A&G Case Management
With the ever-increasing challenges of regulatory requirements, unpredictable volumes, error-prone procedural issues and medical management, handling appeals and grievances (A&G) is an intricate, complex and manually intensive process.
Compliant A&G breaks down these complexities with an automated approach that allows you to efficiently address member and provider complaints while gathering insightful, evidence-based data to improve quality, increase performance and reduce risk.
Automate the tedious manual efforts associated with managing A&G cases.
2 IMPROVE STAR RATINGS, AVOID PENALTIES
Ensure compliance with Medicare and Medicaid rules engines enforcing case rules
3 IMPROVE OUTCOMES & QUALITY
Augment knowledge workers by giving them the data they need when they need and enforce service level compliance
4 GAIN ACTIVE & HISTORICAL INSIGHTS
Search and explore vast amounts of constantly shifting A&G data - all of it - A&G Case, Enrollment, Plan, Benefit, Claim, and Authorization
Software & Compliance as a Service (SCaaS)
The percentage of time the service has been up (Zero-Downtime)
The number of security breaches
The amount of non-compliance penalties paid by our customers
SOME OF OUR CLIENTS INCLUDE
Need to increase your Star ratings and avoid penalties?
Automate compliance and boost quality scores with industry leading Medicare and Medicaid Compliance Rules Engines. Additionally, stay on top of increasing regulatory requirements with our Compliance as a Service.
Medicare and Medicaid Rules Engines / Compliance Monitoring Service
Want to improve outcomes as well as quality?
View your vast amounts of constantly shifting G&A data - all of it. You're not constrained by preconceived notions of how data should be related, but can finally understand how it truly is related. Analyze, reveal, and act.
With built-in Qlik Analytical Dashboards Specific to G&A
Want to improve efficiency and reduce costs?
Automate the tedious administrative tasks associated with managing grievances and appeals, such as: Data Entry, Data Aggregation, Letter Generation, Pending for Information, Follow-Ups, Notifications, and Alerts.
Process Automation Toolkit
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Dramatically improve the efficiency and effectiveness of your operations with CAG.