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Handling appeals, grievances and complaints manually can lead to long resolution times, poor member satisfaction and even fines for non-compliance. QNXT Appeals and Grievance automates and manages the appeals, grievance and complaint process, electronically routing incidents to the right people using business rules you create. Meeting both CMS and Affordable Care Act (ACA) regulatory requirements, the system also provides a central repository for all appeals, grievances and complaints while allowing access to related member, provider, claim and authorization information for tracking and reporting purposes. The result is lower cost and risk, greater efficiency and productivity, and improved member satisfaction.
Appeals and Grievance helps healthcare organizations to:
Appeals, grievance and complaint management
Streamline business processes with greater accuracy and efficiency
Fast, flexible integration of multiple applications
Align Division of Financial Responsibility (DOFR) payment with QNXT
Expanded automation of dental claims to increase efficiency and optimize workflow and accuracy