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Appeals and Grievances

Simplifying Appeals and Grievances processes with tailored solutions to satisfy Compliance Regulations

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October 4, 2022

Streamlining the Prior Authorization Process

Build streamlined authorization workflows for enhanced clinical experiences

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October 18, 2022

When One Size Doesn’t Fit All – Custom Agile Frameworks

David Wallace, Principal Agile Coach at Xero discusses custom agile frameworks

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How AI Can Transform Healthcare? Disambiguation of Healthcare Data

AI is a means to get access, identifying patterns and trends in healthcare data

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When complex, knowledge-based operations rely on manual, paper-based processes, the results are low productivity and a diminishing bottom line.

Excellarate Complaints, Appeals and Grievances solutions help to transform operations that lead to,

  • Faster, smarter investigations and resolutions
  • Increased revenues
  • Lower costs
  • Improved customer satisfaction and retention
  • Higher productivity
  • Greater agility

Excellarate’s tailored Complaint, Appeal and Grievance solutions can:

  • Increase productivity and decision-making as all the relevant information is consolidated in a single view. Drive compliance with state, federal, NCQA, and group guidelines
  • Automatically distribute and prioritize each new complaint or appeal. Capture, catalog, and store all case-related information and documents
  • Track completed and outstanding cases with comprehensive audit trails
  • Automatically match requested information responses for pending cases to the right case file, reactivate the case and notify personnel of the updated status
  • Promote rapid member access to care and claim payments
  • Confidently comply with contractual and regulatory obligations
  • Automatically print the case file for legal discovery or regulatory requests

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