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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.

Grievances Case Management

The CASE Manager automates both clinical and other grievance processes including issue intake, issue investigation, decision making and case closure.

grievancecasemgmt
Letter generation

Letter Generation

The letter generation features provides a comprehensive automated letter generation and tracking process to ensure appropriate and timely member correspondence.

Reports and Dashboards

Pre-built dashboards, reports and trend analysis for various regulatory and quality oversight entities including CMS and NCQA.

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Features

  • Pre-built A&G metadata

    • Configurable as per customer need

  • Issue intake

    • Case entry

  • Case categorization

    • Based on CMS and NCQA requirement

  • Review and assignment

    • Case review & assignment to investigating department

    • Workflow rules for case assignment

  • Issue investigation

    • Case review by department

  • Member correspondence

    • Letter generation

    • Member correspondence tracking

 

  • Reports

    • Standard reports

    • User defined reports

    • Trend analysis report

    • Pre-built Part C and D reports for CMS

    • Pre-built reports for NCQA

  • Management & Operations dashboard

    • Configurable dashboard

    • Trend analysis dashboard

  • Process monitoring

    • Tracking process step for each type of Issue

    • TAT reports and dashboard

  • Rules, alerts and notifications

    • Built-in compliance rules for standard, expedite and other type of cases

    • Configurable alert and notifications

 

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

 

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