The virtual event, which will take place June 10-11, will feature two in-depth case study presentations from organizations that have improved processes to increase efficiency and reduce appeals and grievances. Here’s a look at the two can’t-miss sessions on this year’s agenda.
Case study #1: CareOregon
The first case study presentation will be from CareOregon, a nonprofit health organization that provides health insurance benefits to members across Oregon, and will focus on the use of technology to ensure the capturing of all cases.
Daron Webb, quality assurance manager, and Ally McNally, quality assurance supervisor, will present the session. and discuss the use of a bot for pulling keywords from customer service calls to review for potential appeals and grievance cases; how process improvements were identified through reviewing bot results; and the follow up to help avoid missing appeals and grievances going forward.
The virtual session, Case Study: Use of Technology to Ensure Capturing All Cases, will take place on Tuesday, June 10, at 12:00 p.m. ET.
Case Study #2: Government Employee Health Association
The second case study presentation will be from the Government Employee Health Association, Inc., a self-insured, not-for-profit association that provides medical and dental plans to federal employees and retirees and their families through the Federal Employees Health Benefits program and the Federal Employees Dental and Vision Insurance Program.
The session will spotlight strategies to reduce appeals and grievances.
Kaye Markham, R.N., BSN, CCM, manager of outcomes medical management, and Tammy Gilliland, R.N., BSN, CCM, supervisor of outcomes medical management, will lead the session.
Markham and Gilliland will share how the health plan’s comprehensive approach reduced appeals and grievances by 17 percent, all while improving patient care and increasing efficiency. They will also cover ways to minimize administrative, member, and provider burden in the appeals process; methods to identify and address root causes of denials; and how to use appeals outcomes to inform ongoing adjustments to policies, processes, and training.
The virtual session, Case Study: Strategies for Reducing Appeals and Grievances, will be presented on Wednesday, June 11, at 11:05 a.m. ET.
Other hot-button topics throughout the two-day summit will include:
- Regulatory updates and changes impacting appeals and grievances
- Best practices to prepare for internal and external audits
- FDR management: keeping vendors on track with goals and processes
- Appeals and grievance training to build a strong foundation
- Inquiry, grievance, coverage request, or appeal? How to ensure proper classification
- Enhancing member experience through communication improvements
- Grievance management: responses that build member loyalty
- Keeping your universes in tip-top shape
- How utilization management policies impact appeals
The 10th Annual Optimizing Appeals and Grievances Summit will be held as a virtual event June 10-11. Click here to learn more, including the full agenda and how to register for the event.