RESOLVE

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. 

Miramar:Resolve

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Appeals Management

5

CMS-Required Fields & Functions

5

Thorough Case Validation

5

IRE, ALJ, MAC & JR Case Levels

5

Full Dismissal Processes

5

Official Re-Openings

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Grievance Management

5

Complaint Research, Tracking & Resolution

5

Root Cause & Missed Opportunity Analysis

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SmartWizards

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