MedAdvantage360
CASE STUDY
Industry:
Health Insurance
Products / Services:
Appeals and Grievances Module
Automated homegrown A&G system for a large National Health Plan
Client Background
Client is the largest health benefit plan, with a homegrown appeals and grievance system. It operates with the belief of making care more affordable and empowering the local communities. The company serves 3.3M+ members in South East USA.
Client Requirements
With a presence of large customer base, the client faced issues in manual processing of state reconsiderations. Designing a segregated Appeal and Grievance process for providers and members was challenging. The client lacked a systematic approach to manage multiple applications for various Line of Business (LOBs).
Engagement Highlights
3M+
Membership Count
4
Applications transitioned from System
97%
+ Cases resolved within time limit
Solution Highlights
The automated solution offered insightful dashboards to empower providers with better decision-making capabilities in managing appeals and grievances. The modular solution helped client to manage multiple lines of business such as MA, Dual and Employer Group.
Integrated
Solution
Comprehensive enterprise solution catering to appeals, grievances and reconsiderations
Interactive
Dashboard
Configurable dashboard that offers valuable insights to facilitate better decision making processes
CMS
Compliant
Generation of reports and submissions in accordance with CMS requirements and regulatory mandates
Increased
Efficiency
Eliminated four redundant applications that utilized in integration with multiple manual processes
Audit
Preparedness
Enabled full audit reporting across multiple line of businesses and seamless real-time data integration with the core system
Automated Correspondence
Automated letter generation based on predefined workflows for both members and providers
Modernization of a leading BCBS Health Plan
Wipro implemented end-to-end BPaaS platform with Enrollment, Membership, Agent commissions and Encounters.
Read More>
Leading Medicare Advantage Start-up Plan Implementation
Wipro helped achieve growth objectives and addressed the pressing business needs for a Medicare Advantage
Health Plan.
Read More>