healthcare payers

Appeals & Grievances solution supports Gateways belief in “A Better Way”

Milwaukee, WI, March 15, 2016 – Gateway Health, a top ranked Medicaid and Medicare managed care organization has been delivering quality and affordable healthcare to its members for over 20 years. In concert with Gateway’s strong commitment to doing things “A better way” the selection of Kiriworks as their system integration partner further supports this belief

Looking to replace an aging, rigid system, Gateway was in search of a robust, configurable software solution that would help expedite Member & Provider reconsiderations, redeterminations and grievances for both Medicare and Medicaid.

“I’ve previously had the opportunity to demo and work with some of the largest out-of-the-box solutions in the market,” said Alexander Earlywine, Gateway’s Director of Resolution & Improvement. “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.”

Eric Willis, Kiriworks Executive VP and COO said, “As the market continues to change it is important that payers invest in technology that is quickly adaptable. From the ground-up the Kiriworks A&G suite has been designed to be easily configured to meet market changes. Our partnership with Gateway Health has fostered significant growth of the Kiriworks A&G suite, specifically, new features and enhanced functionality.”

The Kiriworks A&G suite enables Gateway Health to process work more efficiently by tracking cases at each stage in the process. From appointment of representation (AOR) requests to nurse and medical director notes, end users will have increased visibility and better access to information. Automatic generation of notification letters, IRE case packets and creation of universes ensures that all CMS requirements are met. The strong partnership between Kiriworks and Gateway allows for the implementation of an effective Appeals & Grievances solution.

About Kiriworks
Kiriworks, Inc. is a leading provider of process management solutions and services that optimize and transform today’s business. For over 45 years, industry leading technology and expertise from Kiriworks have increased user productivity, reduced operating costs and improved the customer experience for organizations in the insurance, healthcare, government and manufacturing industries. For more information visit Kiriworks.com.

About Gateway Health
Gateway Health is a nationally ranked managed care organization that focuses on providing the best possible healthcare to a growing number of Medicaid and Medicare Advantage consumers. Gateway Health serves the needs of at risk and vulnerable citizens including those facing chronic diseases and those who are Medicare eligible and low-income. The organization provides Medicaid services in Pennsylvania, Delaware and West Virginia and Medicare coverage in Pennsylvania, Kentucky, Ohio and North Carolina. Gateway members have benefitted from services such as disease management, health and wellness programs and preventive care. “A Better Way” is more than a tagline, but what Gateway wants for its members, providers, communities and partners. To learn more about Gateway Health, visit us online at www.gatewayhealthplan.com.

Ford, Chevy…and OnBase?

Maintenance… Whether you love it or hate it, you have to do it. Change your oil, check your fluids, check your brakes, check your tire pressure and tread… If you are like me, these are all things you have heard from either your Dad, a friend, or a mechanic (I am lucky enough to have a brother that happens to […]

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Is Your ECM System an Off-The-Rack or Tailored Fit?

I may not be the most fashionable person, but even I know the difference between something off-the-rack functional that fits like a brown paper bag, and something tailored specifically to fit your measurements. Comparably, software can be crafted the same way. Picture your favorite shirt. You know the one. It’s worn in and comfortable and you can usually be found […]

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Is Your ECM Solution a Baby Boomer?

These days, most every company has at least some sort of digital solution(s) for capturing and processing their documents.  Efforts to reduced the use of paper have spawned various electronic sources (fax, email, mobile, shared folder, etc.) but in the end many of us are still just performing a classic store/retrieve action with our documents. If this is the case for […]

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Risk Management, “It’s in There”

If you have been doing waterfall projects for years and have heard the buzz about agile, your curiosity may be peaked.  Like the old Ragu commercial saying “It’s in There”, many of the most common project risks are resolved simply by the design of the agile approach and no separate Risk Management Process is necessary. The agile software development process […]

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March 16, 2016

Gateway Health(SM) Selects Kiriworks Appeals & Grievances Solution

Appeals & Grievances solution supports Gateways belief in “A Better Way” Milwaukee, WI, March 15, 2016 – Gateway Health, a top ranked Medicaid and Medicare managed care organization has been delivering quality and affordable healthcare to its members for over 20 years. In concert with Gateway’s strong commitment to doing things “A better way” the selection of Kiriworks as their […]
April 29, 2015

Appeals & grievances: 3 tips for the daily triathlon

Last year I completed my first triathlon. Reflecting on the event, I realized that Appeals & Grievances (A&G) managers run a triathlon every day. Triathlons include three events in succession and it’s all about the clock. In an Olympic Triathlon – like I participated in – you start with a one-mile swim, transition to a 25-mile bike ride and finish with […]