Grievance and appeal management is a compliance challenge for many insurers and is critical to ensuring member protection.

Successful management of grievances, appeals and customer Service is critical to consumer loyalty, requiring:

  • Effective, targeted staff training for proper identification and resolution
  • Structured process workflows and work queues for timely case management
  • Standards for data capture and case documentation to support regulatory reporting
  • Robust monitoring and quality review programs to ensure cases are fully resolved
  • Effective and compliant call scripts

ATTAC Consulting Group provides expertise, guidance and solutions for compliant and effective management of grievances and appeals for Medicare Advantage, Part D, Medicaid and HIX programs, including:

  • Grievance and appeal staff training programs 
  • Business process and workflow design and procedure development
  • Development of documentation standards
  • Grievance and appeal systems’ evaluation and implementation support
  • CMS Complaint Tracking Module (CTM) and HIX Health Insurance Casework System (HICS) support
  • Data validation and compliance testing
  • Root-cause analysis support