The solution segments the complex A&G process into concise, contained, and clearly defined activities routed selectively to the appropriate teams – Triager, Case Owner, Registered Nurse and Medical Director.
Targeted critical data
Display of relevant data up-front to support user decisions – enrich complaint case with authorization or claims data based on pre-service or post-service appeals.
Dynamic SLA Management
Ease of managing State specific and Line of business specific Service Levels mandated by regulatory guidelines.