Appeals and grievances in patient care are often time consuming and challenging processes for the patients and healthcare providers. Fragmented data spread across silos in the healthcare payer’s system can impact the costs per appeal, turnaround time, and customer experience.

Wipro’s advanced analytics capabilities help track the origin of appeals across regions to ensure timely resolution. Our in-house automation suite further transforms the process flow resulting in improved efficiency and reduced turnaround time. Organizations can take corrective actions to finetune processes like benefit or pricing configurations and claims adjudication, thus reducing the volume of appeals.

Wipro has reimagined the appeals process leveraging an OCR engine to extract legitimate information from the appeals document. Bots help to research and extract data from the Source of Truth (SOT) for Escalation Tracking System (ETS) load.

Wipro’s automation solution minimizes the appeal adjustment cases in addition to benefits such as:

• 100% regulatory compliance reporting enabled by complete appeals and grievances lifecycle support, automation, BI, and analytics
• 97% reduction in missed acknowledgment letters
• Reduction in appeal resolution turnaround time by 3 days
• Reduction of out-of-compliance contributor by ~50%
• 70% improvement in efficiency of appeal resolution