APPEALS AND GRIEVANCES
Capture Complete Clarity with an Automated, Intelligent A&G Solution
A lack of visibility into your appeals and grievances inventory creates frustrating workflows and slowdowns. The i3 Appeals & Grievances solution empowers you with real-time data and intelligent workflows, automating tedious tasks such as document generation. Eliminate the need to toggle between multiple applications with a centralized platform that reduces wasted time and improves efficiency.
Clear Visibility Across Medicare, Medicaid and Commercial Lines of Business
An incomplete view of appeals and grievances inventories offers limited visibility and an increased risk for errors. Our comprehensive solution provides a direct line of sight into your cases, whether you’re managing Medicare, Medicaid or commercial lines of business.
We configure our systems to adapt easily to your unique requirements, offering real-time data and streamlined workflows. Automated document generation, centralized data access and intelligent processes allow your team to reclaim their time and create efficiency across all business lines.
i3 Appeals & Grievances
Manual processes in appeals and grievances workflows introduce risk for compliance issues and visibility gaps. The i3 Appeals and Grievances solution addresses these challenges with a comprehensive approach that:
- Leverages your existing data, eliminating the need for data migration or ownership.
- Automates the correspondence generation process, saving time and ensuring accuracy. Users don’t need to know or find the appropriate template; the system selects it for them.
- Creates packages for Medicare, collecting different case documents without manually transferring documents from various systems.
- Easily performs mock audits; enter a date range and click “run” to allow users to slice and dice the data.
- Provides interactive and customizable dashboards that offer downstream information to other departments.
- Integrates with existing systems such as Salesforce, enabling a frictionless user experience.
Medicare A&G Benefits
- Automatically generates CMS Universe reports with a single click, ensuring data accuracy and compliance with CMS requirements.
- Creates packages for Medicare, collecting different case documents without manually transferring files from various systems.
- Enables proactive management of report quality to mitigate risk around penalties for timeliness and ensure compliance during audits.
- Provides real-time process insight through reporting dashboards, allowing managers to monitor due dates and receive alerts for potential compliance issues.
Universal A&G (Medicaid & Commercial) Benefits
- Offers a flexible Plan Scenario feature, allowing configuration of activities based on specific state and/or plan needs, supporting compliance with federal and state regulations.
- Serves as a single source of truth, allowing users to sort, change, and review rules by state or plan, SLAs, and other specialized criteria.
- Facilitates easy viewing and reporting on all cases and performance metrics associated with individual states and/or plans.