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Focusing on compliance from intake to resolution, Miramar:Resolve facilitates accuracy and timeliness. With a one-screen view of all case activities, case processors are able 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
Appeals Management
CMS-Required Fields & Functions
Thorough Case Validation
IRE, ALJ, MAC & JR Case Levels
Full Dismissal Processes
Official Re-Openings
Grievance Management
Complaint Research, Tracking & Resolution
Root Cause & Missed Opportunity Analysis
SmartWizards
Questions?
Contact one of our sales representatives to learn more.They will quickly get you in touch with the subject matter experts and ensure your detailed questions are answered.