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Growing backlogs, dissatisfied providers and potential regulatory non-compliance issues are very real challenges for healthcare providers relying on manual workflows. QNXT Workflow outcome processing engines help reduce costs, improve operational efficiency and increase automation by helping to prioritize, triage and reduce pending and exception claims, utilization management inventory, and appeals & grievances tasks.
QNXT™ Claims Workflow helps healthcare organizations manage claim inventory more efficiently by automating the process of prioritizing, triaging and reducing pended and exception claims. The result is streamlined claims adjudication management, reduced costs and improved speed, accuracy, efficiency and compliance. Features include:
Designed to help plans manage the inventory of Utilization Management (UM) documents, QNXT™ Utilization Management Workflow helps healthcare organizations prioritize, triage and reduce lagging pended UM or referral requests. The result is improved efficiency, reduced costs, and enhanced supervisor and staff productivity. Features include:
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. The result is lower cost and risk, greater efficiency and productivity, and improved member satisfaction. Appeals and Grievance helps healthcare organizations to:
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
A comprehensive native robot marketplace to accelerate implementation, operational efficiency, scalability, and savings.