Appeals and Grievances
Simplifying Appeals & Grievances with Custom Applications that Meet All Compliance Regulations
When complex, knowledge-based operations rely on manual, paper-based processes, the results are low productivity and a diminishing bottom line. With Prime's Complaints, Appeals and Grievances solution, our clients transform their operations for…
- Faster, smarter investigations and resolutions
- Increased revenues
- Lower costs
- Improved customer satisfaction and retention
- Higher productivity
- Greater agility
Prime's custom applications for Complaints, Appeals and Grievances can...
- Increase productivity and decision-making as all the relevant information is consolidated in a single view
- Drive compliance with state, federal, NCQA and group guidelines
- Automatically distribute and prioritize each new complaint or appeal
- Capture, catalog and store all case-related information and documents
- Track completed and outstanding cases with comprehensive audit trails
- Automatically match requested information responses for pending cases to the right case file, reactivate the case and notify personnel of the updated status
- Promote rapid member access to care and claim payments
- Confidently comply with contractual and regulatory obligations
- Automatically print the case file for legal discovery or regulatory requests
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