UMR, a division of UnitedHealthcare
Hyland helps third-party administrator automate appeal and grievance processing.
The technology that UMR used to support A&G processing did not address all its needs to support collection, storage, routing and management of appeals and grievances. Staff spent time searching across departments and answering calls about the status of an appeal. This cumbersome administration process left less time for clinical review and appeal decisions.
Our OnBase appeals and grievance solution implemented by Kiriworks makes it easy to take an appeal from one work stream to another and keep it intact to provide a fast and sound decision back to our customers.
— Breck Blennert, Post Service Appeals Manager, UMR, a UnitedHealthcare company
All member and provider information required to process appeals and grievances is now housed in OnBase, one of Hyland’s content services platforms. The appeal and grievance solution built in OnBase provides end-to-end case management, compliance reporting, performance monitoring and correspondence management. Implemented and customized by business partner Kiriworks, the A&G application delivers on UMR’s requirements.
Member and customer satisfaction
Thanks to OnBase, there’s no need to call UMR and wait on hold for a service representative to look up the member ID, see if an appeal has been received, check on its status and determine if additional documentation is needed. The integration with OnBase allows members to see the status of their appeal directly within the UMR portal.
Fewer calls to find documentation and check on A&G status means staff have more time for clinical review, consideration and decision. Personnel no longer waste time looking for member documents because they are available for enterprise access within OnBase. Real-time monitoring also helps prevent staff from missing state deadlines. Automated routing and correspondence expedite completion of the appeals process.
The rules-based A&G software with real-time reporting dashboards provides for timely management of appeals based on each plan or state’s regulatory guidelines to prevent fines and other penalties. It is easily adaptable to support changes in statutes.