Appeals and Grievances

Appeals and Grievances

Manage CMS Compliance AND Boost Member Satisfaction

With appeals and grievances (A&G) under the CMS microscope, health plans need a platform to improve compliance, lower operating costs, increase Star Ratings and quality scores, and minimize penalties.

Just as important: Boosting member and provider satisfaction to drive a stronger network.

Organizations can stay ahead of the game with proactive A&G management that:

  • Eases compliance with regulatory requirements
  • Protects revenue by helping prevent penalties
  • Lowers the operational and labor costs associated with Universe creation
  • Automates the generation of A&G letters
  • Improves member retention and health outcomes


Know where your appeals and grievances stand, down to the second

With the Aerial Appeals and Grievances app, health plans have fast, automated A&G processing to meet regulatory requirements and support stronger patient and provider relationships.

Our workflow manager and reporting dashboard can help organizations:

  • Standardize and automate processes to meet, maintain, and get a step ahead of CMS requirements
  • Improve network performance visibility to optimize services and enhance network quality, data integrity and efficiency
  • Reduce disenrollment and associated new-customer acquisition costs
  • Decrease labor costs and avoid penalties with quick, easy and accurate Universe creation for audit-readiness
  • Gain visibility into which providers have the highest and lowest grievance levels
  • Remove lower quality services to strengthen ratings and ensure compliance — optimizing 2 of 5 Star Rating factors
  • Better align benefit guidelines and system applications
  • Identify opportunities for improved communication around benefits schedules
  • Effortlessly generate “Letters” for ease of distribution, archival and retrieval

With Aerial™, organizations can track A&G instances down to the second and always be ready to meet CMS reporting needs. Plus, they gain valuable insight to reduce costs, provide better services and communicate more effectively with members – all vital components of care management.

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Aerial Complex Care Management™ and Aerial Insights™ are NCQA Population Health Management Prevalidated with possible autocredit designation, awarded in standards year 2018. Find out how your organization can benefit.