Appeals & 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 & 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.