With unpredictable volume, varying service agreement levels and concerns ranging from simple procedural issues to matters of life and death, managing insurance appeals and grievances (A&G) is a complex, labor-intensive process – especially when managed manually.
By automating much of the A&G process, OnBase expedites case distribution and prioritization while balancing workloads.
At the point of capture, OnBase automatically classifies materials against a set of criteria to determine if the appeal is life-threatening (i.e. it requires medication correction or medical treatment), or if it's monetary (e.g. an adjustment to deductible), and then routes assignments accordingly.
Using an easy-to-use interface, providers may submit A&G materials directly to OnBase through a portal, immediately triggering workflow. OnBase automatically routes information for review and approval, and when appropriate, creates the correct correspondence – whether that's an initial acknowledgement letter, a determination letter, or a payment authorization notice.
By streamlining what was once a high-volume, time- and labor-intensive process, OnBase offers payers an efficient way to manage healthcare appeals and grievances. The solution also makes audits more efficient by keeping an audit trail of the entire A&G process with full visibility into what approvals and documents were distributed, complete with date and time stamps.