Automation makes a difference in A&G

Impacted by both Centers for Medicare and Medicaid Services (CMS) and state-level guidelines, the Appeals and Grievances (A&G) process is one of the most monitored and regulated for healthcare payers. These requirements influence everything from response times and escalation to tracking and reporting.

To avoid penalties for noncompliance, and more importantly, improve member satisfaction, healthcare payers must continually search for ways to make their A&G processes more efficient.

Automating highly manual steps in the process by using document management, workflow and business process automation (BPA) technologies can go a long way in helping you improve your A&G services. Two of the key ways automation helps make A&G processes more efficient are by streamlining correspondence and expediting case routing and management.

Streamline correspondence, expedite case management

State and federal regulations require certain A&G notifications to occur within specific timeframes and adhere to certain standards. Manually creating this correspondence and reviewing variations in content is a time-consuming, error-prone process that can jeopardize compliance.

By leveraging technology that helps you develop a library of standardized correspondence templates, you minimize the labor required to complete this task. Furthermore, data capture and extraction tools can identify member data that already exists within other enterprise applications – data that can automatically populate the appropriate document templates. Automating this effort not only saves time, it reduces opportunities for human error and ensures data consistency and integrity.

You can also utilize automated, rule-based workflows to assist in data collection and case assignment. Using these tools, you ensure cases are routed to the people or groups with the best availability or right expertise. Priority cases can also be identified using this technology and appropriately escalated, all of which ensures timely, consistent processes with minimal manual intervention.

Automation results in real-world time savings

VNSNY CHOICE is one healthcare payer that has realized first-hand the impact automation can have on A&G processes. This New York-based health plan has saved time and enhanced security by leveraging document and workflow automation.

“Automatic case assignment and template population has helped cut a good 30 minutes out of the time it previously took to process each case,” said Tanya McCray, vice president, Grievance and Appeals and Vendor Management at VNSNY CHOICE.

You can read about VNSNY CHOICE’s entire journey in this case study.

Enhance file management and security

Automation can do much more than streamline correspondence and expedite case management. The right data capture, document management and workflow technologies can improve file management and security as well.

For example, document and process management tools can automatically alert staff when supporting documentation is missing from case files. Moreover, with integration, direct links to supporting documentation can be made available from within core administrative applications. Finally, time stamps and file location data can also help provide a complete digital history of the case files and corresponding documents while digital repositories ensure files are protected from exposure or loss.

All of these benefits translate to faster case resolution that ensures compliance and improves member satisfaction. To learn more about how Hyland Healthcare’s end-to-end A&G solution can meet all your automation needs, click here.

Ken Congdon has expertise in the healthcare technology industry and has been a contributor to the Hyland blog.
Ken Congdon

Ken Congdon

Ken Congdon has expertise in the healthcare technology industry and has been a contributor to the Hyland blog.

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