The Added Value of Automation for Appeals and Grievances Processes

The appeals and grievances process is highly regulated, scrutinized and monitored, so it is critical for healthcare payers to manage it efficiently from end to end. But beyond meeting strict compliance requirements, healthcare payers are finding that efficiency pays – in more ways than one.

Today, the key to improving efficiency is to eliminate as many manual procedures as possible by increasing automation. Happily, the appeals and grievances process, from case creation to resolution, lends itself perfectly to automation – especially when using state-of-the-art solutions for document management, business process management and business activity monitoring.

A more automated approach to managing appeals and grievances will enable you to:

• 1. Streamline communications

  Using best practice templates, innovative technology solutions can guide coordinators through communications with members and providers – minimizing manual effort, standardizing the creation of traditional correspondence items and increasing process visibility.

• 2. Simplify file management

  A well-coordinated combination of process and content management technologies can automatically alert you to the arrival of physician reports and other supporting documents and attach them to the relevant case file for review. Reduce your paper burden with digital capture of data that offers time stamps, file location data and integration with core administration systems.

• 3. Save time

  With automated, flexible rules-based workflows that cover most data collection and case tracking tasks, you can ensure timely, consistent processes that provide a rapid return on investment in new technology. Populate data systems with ease, streamline routing for expedited cases, align the right people with the right tasks and automate the pulling and pushing of information from disparate systems, for faster decision-making.

• 4. Minimize risk

  By centralizing all elements of the process, you can consistently provide a full, accurate case history and reproduce all associated communication, while protecting data from unauthorized access. An aging calendar and continual monitoring of milestones and deadlines will support constant adherence to updated compliance requirements. And as new data arrives, in any format, the system will automatically reconcile vaulted case files with the new information in seconds.

Ultimately, automating the appeals and grievances process will help you resolve cases more rapidly and reduce operational errors – creating a more positive customer experience as a result.

Accelerated resolution and consistent service are vital to keeping customers happy, which is great news for your bottom line as it adds value where your business needs it most.

Find out more in our new white paper.