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:

• Automatic identification, prioritization and routing of UM documents to end users
• Real-time delivery of work items via seamless integration with QNXT™
• User-configurable UM queues
• Real-time views of employee utilization and work queues
• Natural language configuration of end-user desk-level requirements
• Prioritization of UM items to meet timely resolution and compliance requirements

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:

• Reduce costs
• Track communications, documents and resolution timeframes in real time
• Prioritize work items and submit 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