Inovaare’s Grievances software enables organization to manage various types of member grievances. The system provides end-to-end process from case intake to case closure. With built-in regulatory rules and appropriate case categorization, the grievances system helps organization to achieve regulatory compliance and quality mandates.
Features
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Pre-built A&G metadata
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Configurable as per customer need
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Issue intake
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Case entry
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Case categorization
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Based on CMS and NCQA requirement
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Review and assignment
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Case review & assignment to investigating department
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Workflow rules for case assignment
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Issue investigation
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Case review by department
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Member correspondence
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Letter generation
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Member correspondence tracking
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Reports
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Standard reports
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User defined reports
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Trend analysis report
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Pre-built Part C and D reports for CMS
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Pre-built reports for NCQA
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Management & Operations dashboard
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Configurable dashboard
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Trend analysis dashboard
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Process monitoring
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Tracking process step for each type of Issue
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TAT reports and dashboard
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Rules, alerts and notifications
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Built-in compliance rules for standard, expedite and other type of cases
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Configurable alert and notifications
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Benefits
- Helps organization to be CMS compliant
- Appropriate case categorization and process control and visibility
- Generates NCQA reporting and Part C & D reporting
- Improves organization CMS Star Rating