Appeals & Grievances

Life is full of different experiences. Take a moment to think about the last really good experience you had. What was it about the experience that made it so positive? Now think about the last horrible experience you had. What was it that made the experience so poor? I’m betting the factors behind why the experience was positive or negative were clear and they may have had very little to do with the actual quality of the product. 

Healthcare payers focus a significant amount of time and money on improving their member and provider experience, as they should. However, what many payers overlook is that by taking steps to improve employee experiences, you in turn improve both member & providers experience. Think about the last time you had to make a return to a store or call someone about a mistake on a bill. When you spoke to a customer service agent did it impact your response and overall experience? If the customer service agent is understanding, sympathetic and empowered to resolve the issue quickly it makes for a positive experience for you. If they are rude, take forever to rectify the situation or imply that the problem is somehow your fault, how do you respond? How do you describe the experience to others? Doesn’t it impact your willingness to do business with them in the future? Studies have shown that understanding and improving the employee experience is critical for companies operating in a highly competitive global economy because attracting and retaining skilled employees is imperative to what drives a strong customer experience.

How would you describe everyday life for your Appeals & Grievances team? Are they stressed out trying to process appeals in a time frame that maintains corporate and CMS compliance? Do they dread receiving a letter that states an audit is right around the corner? Do they have to scramble around putting in long hours and missing lunches to ensure Universes are created and the data is correct? If this sounds familiar there are ways to improve the employee experience, build departmental collaboration, easily create Universes with the click of a mouse – all while making employees feel confident in their contributions and productivity. Enter digital transformation.

Technology solutions are designed to streamline the Appeals & Grievances process, improving compliance, increasing productivity and boosting member, provider & EMPLOYEE experiences. How does digital transformation change the employee experience? It’s simple:

  • Instead of managing data in excel spreadsheets or on paper, cases are electronic, and data can be leveraged across the enterprise. Technology can then ensure CMS compliance deadlines and regulatory requirements.
  • Providing advanced notifications to employees when deadlines are approaching so that action can take place and a timely decision can be made. No more running around and scrambling last minute to get answers.
  • Reduce stress and long hours needed to complete cases, workloads can be managed up front and distributed accordingly.
  • The nightmares that ensue with the word…Universe are no more! Universe reports can be created with the click of a mouse – simplifying the process and saving time.

Improving member experience should always be at the forefront of any healthcare payer strategy. Happy members are what keeps your business thriving, but so are happy employees. Focusing on innovation and improving your internal processes kills two birds with one stone and improves the experience for everyone. What are you waiting for?

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New Innovations: Provider Outreach

The software industry today is a diverse and dynamic industry with products readily available to meet just about every business need imaginable.  But what do you do when you need a product that can send thousands of surveys, attestations, or general outreach to your providers?  What options are you using when you need the data to be returned to your […]

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The 10-Year Challenge

The most recent social media trend has been the 10-year challenge, when an individual posts a picture on a social media platform like Facebook, Instagram, Snapchat or Twitter, and compares a picture of themselves from 2009 to 2019. Which typically sparks a conversation between followers and friends of how so much has changed within the 10-year time span.   2009 to today has […]

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Don’t listen to what they say – GO SEE.

Greetings and welcome to 2019!   As you begin planning your new year and accomplishing goals, we wanted to share with you some upcoming healthcare related conferences we will be supporting in February, March and April. First we’re looking forward to getting out of the Cleveland winter and heading to at HIMSS19 in Orlando, Florida.  Seema Verma and Alex Azar will […]

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Submit or Not to Submit? That is the AOR question.

Appointment of Representative, (aka the AOR) always seems to be a topic of conversation in the healthcare payer space. Every show we attend, every customer we talk with and every industry function we attend, there are intense conversations and differing opinions on what is required by CMS. Do you only submit an AOR once? Do you need to submit a […]

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May 22, 2018

The Secret to Improving Member Experience? Hint: It’s Probably Not What You Think.

Life is full of different experiences. Take a moment to think about the last really good experience you had. What was it about the experience that made it so positive? Now think about the last horrible experience you had. What was it that made the experience so poor? I’m betting the factors behind why the experience was positive or negative […]