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TruCare® Administrative Appeals and Grievances

Empowers appeals and grievances professionals (customer service reps, appeals coordinators, appeals reviewers, and independent review organizations) to operate efficiently with reduced reliance on information technology support

How we help

Maintain continuous compliance while reaching the correct resolution for each member or provider

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Streamlines End-to-End Workflows

Using our Business Rules Engine, users can configure service levels and turnaround time by appeal and grievance type (for review, approval, and correspondence), ensuring consistent processing and adherence to business and regulatory requirements.

Interlinked to Utilization Management

Interlinked to our utilization management tools at the authorization detail level. Our automated tasks include receipt acknowledgments, notifications, correspondence, and peer-to-peer and external review for all levels of appeals.

Make Next-Gen Population Health a part of your care model

Key Value-based Features

What makes TruCare a truly unique and integrated population healthcare solution is our all-in-one platform and the wrap-around features that support every aspect of the tool

Create smart appeal/grievance cases based on classification and line of business from their composite complaint.

Drive standard operating procedures for internal and external authorization workflows based on custom rules, decreasing claims errors and rework, avoiding unnecessary utilization, and increasing standardization.

Incorporate member eligibility details from core systems using our pre-built integration frameworks and extensive APIs.

Industry-standard processes for intake, level 1 - level 5 reviews, and decisions/outcomes with documentation-attachment capability are configurable by the line of business, geography, and more.

Role-based automation for next steps, rules, and templates, eliminating time spent searching, reducing errors, and increasing efficiency.

Effortless template-driven documentation for internal/external audiences with structured notes to meet organization and program requirements.

Send automatic acknowledgments and resolution letters to maintain regulatory compliance for all cases.

Add documents to relevant cases with the help of the integrated document repository.

Operational reporting to support user decision-making and effectively manage complaints, correspondences, appeals and grievances, claims, and authorizations.

Maintain better adherence to regulatory guidelines through compliant and accelerated case resolutions.

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