A Comprehensive Appeals, Grievances and Complaint Tracking System
A Highly Customizable and Configurable System
Schedule a DemoMedAdvantage360
Wipro's AG360 system allows Medicare Advantage Organizations (MAOs) to comprehensively manage their end-to-end Appeals & Grievances (A&G) process, and contains a Complaint Tracking System (CTS).
With healthcare reform and regulatory amendments driving transformational changes in the sector, Wipro offers MAOs a suite of technology systems to help them remain compliant with CMS (Centers for Medicare and Medicaid Services) mandates and to enhance the quality of care delivered to their members.
The AG360 product enables plans to process, track and identify all incoming Appeals, Grievances and complaints to ensure they remain compliant with CMS's changing regulatory requirements. The software also allows users to issue and track the required CMS letters within the specified turnaround timeframes.
Wipro's AG360 system can be purchased as a standalone system, or bundled as the newest component to Wipro's Member360 comprehensive suite of products.
AG360 platform - Process flow
Key Highlights
- Internet-based Software as a Service (SaaS) standalone system
- Management and individual user Volume and Aging Dashboard
- Ad hoc reporting and user queries
- CMS-Required Correspondence generated real time
- Email notification and routing assignments
- Document attachments
- Flexible Plan control field and user access
- Reminder emails when an item is about to become past due
CMS Star Rating
Wipro's AG360 product is designed to help MAOs address their goal of improving their CMS Star Rating. Medicare plans that earn a rating of three or higher are eligible to receive federal bonus payments and those earning a five-star rating, in addition to the bonus payments, will be eligible for continuous enrollment and the ability to market their products year-round.
How will AG360 benefit your plan?
- Tracks cases at each stage of the process to ensure plans remain compliant
- Issues the required letters to the member and stores them within each record for audit purposes
- Plans can attach documentation to member records in order to eliminate paper files
- Allows plans to monitor staff on turnaround times for closure of cases
- Allows plans to identify and track key areas of performance which are tied to the Star rating system
- Helps plans create the required Part C and D reporting as required by CMS
Solution Features
Software as a Service (SaaS) Delivery
- Identify, process and tracks cases at each stage of the process
- Easily customizable to handle any type of appeal or grievance
- Plans can attach electronic medical records to each case in order to
- eliminate paper files
- Support all CMS approved letter templates including We support foreign
- language templates
- Provides all CMS required reports including the CDAG/ODAG reports, known as Universe reports
- Customizable Case Ability for ALJ, LEP, MAC, QIO Appeals, Good Cause Requests
- Case assignments and case history
- Automatic and configurable email alerting
- Export to Excel provides for downstream data analysis