Healthcare Payer Solutions

Healthcare Payers face many challenges in the healthcare industry, from expanding regulations to improving the member and provider experience. The demands are high and disruption is everywhere. Kiriworks is focused on assisting payers with these challenges and keeping up with the constant increased expectations they are faced with each day. Our solutions touch multiple departments, such as Appeals & Grievances, Network Operations, Member Services, Compliance, Back Office and IT. Our solutions built on the industry leading content services platform by Hyland – help drive accelerated performance and innovation to meet the demands of this dynamic industry.

Kiriworks appeals and grievances manages every aspect of the process

Appeals & Grievances

Kiriworks A&G manages every aspect of the appeals and grievances process. From Medicare, Medicaid and Commercial plans - Kiriworks A&G has been designed with compliance at the center of the solution. Kiriworks A&G starts managing and monitoring the process the second an appeal, grievance, compliant or inquiry is received. From automated correspondence creation, IRE packet generation, CDAG & ODAG universe reporting, data validation reporting and real-time process dashboards - Kiriworks A&G has you covered.

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Kiriworks Organization Determinations brings holistic approach to managing healthcare payer organizations

Organization Determinations

As an extension of the Kiriworks A&G for Medicare solution accelerator, Kiriworks Organization Determinations brings the same holistic, case management approach to managing a healthcare payer's organization or initial determinations. Kiriworks Organization Determinations manages the request from intake through resolution with auto-calculated due dates, system-generated notifications and a portfolio of management and regulatory reports.

Kiriworks network development and contracting creates a collaborative approach to the contracting process

Network Development & Contracting

Kiriworks Network Development & Contracting is designed to create a collaborative approach to the provider contracting process. With integrated workflow automation and content services, Kiriworks Network Development & Contracting automates and manages the process from provider recruitment to contract management (creation, negotiation and execution) through provider onboarding and renewal/termination management.

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Kiriworks provider outreach, manage your outreach program

Provider Outreach

Kiriworks Provider Outreach is a platform designed to manage the outreach and analyze the responses of a healthcare payers provider network. Kiriworks Provider Outreach is used to design, distribute, manage and report on all aspects of your provider outreach program. Whether you are sending attestations, surveys, questionnaires or friendly reminders, Kiriworks Provider Outreach is a way to bridge the communication gap between your provider network.

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Kiriworks transforms healthcare payer credentialing process

Provider Credentialing

Part of the Kiriworks Provider Management Platform, Kiriworks Provider Credentialing enables healthcare payers to digitally transform their credentialing process. Kiriworks Provider Credentialing can be used by healthcare payers as a stand along application or connected to the Kiriworks Network Development & Contracting solution accelerator. Kiriworks Provider Credentialing guides users through the credentialing process with configurable activities based upon regulations, policies and state requirements.

Kiriworks provider site surveys for healthcare payer industry

Provider Site Surveys

Another component of the Kiriworks Provider Management Platform is Kiriworks Provider Site Surveys. Whether a site survey is triggered during the provider contracting process or based upon a grievance related to a member's experience with a provider - Kiriworks Provider Site Surveys delivers healthcare payers a complete mobile survey experience that is directly connected to their provider data and the case that initiated the site visit. Users have the ability to conduct their site visit from a mobile device while capturing video and photo and completing the required questionnaires.

Kiriworks content connect enabling healthcare payers

Content Connect

Content Connect leverages a healthcare payer's existing secure infrastructure and services to digitally route the right information to the right person at the right time. Content Connect enables payers and providers to share data and documents in seconds, not days, while eliminating lost or misplaced information. By ensuring authorized users have immediate access to accurate, up-to-date data and documents, Content Connect facilitates improved communication with both payers and providers.

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“The Appeals & Grievance solution designed by Kiriworks is one of the most innovative and configurable solution I’ve encountered. It has the ability to process any line of business and when calculating the ROI on this product, it is easy to see how the cross company usages of this product reveal it pays for itself in no time.”
Director of Appeals & Grievances, Gateway Health