Robust, easy-to-use grievance and appeals 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.
Grievances and appeals 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.
Complaint Research, Tracking & Resolution
Root Cause & Missed Opportunity Analysis
CMS-Required Fields & Functions
Thorough Case Validation
IRE, ALJ, MAC & JR Case Levels
Full Dismissal Processes
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