The document describes the process flow for appeals and grievances for a healthcare provider using Newgen's Customer Communication Management solution. The process involves appellants registering appeals/grievances via various channels. A data entry agent then enters the details into Newgen's CCM solution, triggering an auto-generated acknowledgment email. A reviewer makes an approval/exception decision and the committee makes the final call. An approval letter is generated and sent to the appellant if approved.
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Interactive Customer Communication Management (CCM)
2. Process Flow for Appeals & Grievances Process for a Healthcare Provider
3. Appellant registers his appeals/ grievances via different channels like email, snail mail, fax, telephonic call etc.. Process Flow for Appeals & Grievances Process for a Healthcare Provider
4. Auto generated acknowledgement mail is sent to the appellant soon after the Data Entry Agent registers the appeal into Newgen’s CCM solution for Interactive Communication Process Flow for Appeals & Grievances Process for a Healthcare Provider
5. The Reviewer takes necessary decision on approval or raising an exception for modifications or even discard the appeal with reasoning and remarks.Process Flow for Appeals & Grievances Process for a Healthcare Provider
6. The committee reviews the Reviewer’s decision and takes the final call on approval of the Appeal. Process Flow for Appeals & Grievances Process for a Healthcare Provider
7. Approval Letter generated over the predefined templates is sent to the appellant and also archived into OmniDocs –DMS , integrated part of Newgen’s CCM SolutionProcess Flow for Appeals & Grievances Process for a Healthcare Provider
10. DE Operator initiates a new transaction for every new appeal or grievance entering from different channels.
11. The operator keys in details corresponding to the Appeal on the form created in Newgen's form designer - OmniForm , within the Newgen’s CCM framework