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Improve Client Satisfaction

APPEALS, GRIEVANCE AND COMPLAINT MANAGEMENT

Use business rules to electronically route incidents to the right people for prompt attention and resolution.

AUTOMATE PROCESSES AND CREATE AUDIT TRAILS


Align appeals and grievances processing tasks with appropriate personnel and adhere to applicable CMS and ACA timelines.

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:

  • Reduce costs
  • Track communications, documents and resolution timeframes in real time
  • Prioritize work items and submits via streamlined, rules-driven routing
  • Align tasks with appropriate personnel
  • Adhere to applicable CMS and ACA timelines with client configuration
  • Create comprehensive audit trails
  • Alert users to at-risk, time-sensitive items
  • Provide easy access to case files for CMS audits
 

QNXT MODULAR ADD-ONS

QNXT™ Appeals and Grievance Workflow™

Appeals, grievance and complaint management

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QNXT™ Claims Workflow™

Streamline business processes with greater accuracy and efficiency

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QNXT™ EXtended Integration™ (QXI)

Fast, flexible integration of multiple applications

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QNXT™ DOFR Module

Align Division of Financial Responsibility (DOFR) payment with QNXT

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RELATED THINKING

Solution Summary
TriZetto® QNXT Appeals and Grievance Workflow™

Streamline Appeals, Grievance and Complaint Management

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At Cognizant, we are here to provide you with more information about our TriZetto Healthcare Products software and service solutions and answer any questions you may have.

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