Robust, easy-to-use appeals and grievance solution – focusing on compliance from intake to resolution.
Miramar:Resolve facilitates accuracy and timeliness, with a one-screen view of all case activities, allowing the case processor to capture the “story” of an appeal or grievance.
Appeals and grievances are a natural part of Medicare beneficiary management. Being able to handle these processes is only one facet of Miramar:Resolve.
The ability to capture detailed information of a member’s interaction is critical for the health plan so that a clearer picture of the grievance is identified.
Case processors are seamlessly guided through complex CMS processes specific to a case type, leading them to a compliant resolution for the member and the health plan.
Miramar:Resolve enables your health plan to easily provide a root cause analysis for each grievance type, and initiate process improvements to aid in long term grievance reduction and customer satisfaction.