Overview

Miramar:Resolve, developed by Convey Health Solutions, is a comprehensive appeals and grievance management solution designed to streamline and enhance Medicare and Medicaid beneficiary management. The platform emphasizes compliance throughout the entire process, ensuring timely and accurate resolutions for both appeals and grievances. By providing case processors with a single-screen view of all activities, it simplifies tracking, case validation, and interaction documentation. The solution allows health plans to conduct root cause analysis and improve long-term grievance resolution, enhancing customer satisfaction and reducing grievances.

Features and Capabilities

• Appeals Management: Handles complex CMS processes for case types, ensuring compliant resolutions.
• Grievance Management: Tracks complaints and facilitates resolution, including research and analysis.
• CMS Compliance: Supports required fields and functions for Medicare and Medicaid cases.
• Thorough Case Validation: Ensures comprehensive validation throughout the case lifecycle.
• Root Cause Analysis: Identifies opportunities for process improvements and grievance reduction.
• Multi-Level Case Support: Supports various levels of case escalation, including IRE, ALJ, MAC, and JR.
• Full Dismissal and Re-Opening Processes: Manages official case dismissals and re-openings.
• SmartWizards: Provides guided workflows to ensure accuracy and efficiency.
• Long-Term Improvement Focus: Initiates process improvements to reduce grievances and improve customer satisfaction