Is It Time to Optimize Your Grievances & Appeals Department?

Grievances and appeals—common to industries such as insurance and healthcare—are heavily regulated by both federal and state laws. That means it’s extremely important that their receipt, decision, and resolution process are continuously tracked and reviewed in order to remain in compliance.

Delays along the way provide a poor customer experience, and gaps or errors in documentation can lead to hefty noncompliance penalties. No matter how you look at it, failing to update and streamline your grievances and appeals processes is bad for business. If you’re struggling to resolve grievances and appeals quickly or document your processes accurately, it’s time to ask yourself this one important question: is it time to optimize your grievances and appeals department?

Optimizing grievances and appeals with a digital mailroom

Many problems that grievances and appeals departments face stem from having too much paperwork to deal with. This could mean anything from having an insufficient number of employees on board to process it, inefficiently managing paper files, or sticking with outdated workflows that are prone to bottlenecks.

Take a look at the below list of other common grievances and appeals difficulties. Do they sound familiar?

• Trouble responding to and resolving grievances and appeals on time
• Inefficient document flows causing bottlenecks and slowdowns
• High risk of losing and misplacing documents
• The need for more staff to handle the volume but reluctance due to high costs
• Difficulty tracking dates of receipt, which complicates audits
• Wasting space and money on paper document storage

If you’re struggling with these things, it’s time to make a fundamental change in the way your grievances and appeals department works—and it all starts with bringing your mailroom into the digital era. Documents, both paper and digital, enter your business via an inbox. This means that to optimize your grievances and appeals process, the inbox is where you need to start.

Let’s take a look at how implementing a digital mailroom can improve efficiency across the board.

Improve grievance response time

Responding to and resolving grievances and appeals is a time-sensitive task. The more time you need to receive, open, and sort correspondence, the lower your chances of handling inquiries on time. Since grievances and appeals are required to be handled within specific timeframes, slow processing also complicates compliance management.

By contrast, with a digital mailroom, all your correspondence is processed almost immediately after receipt without spending any time waiting in your mailroom or gathering dust on someone’s desk. This significantly reduces the time from receipt to resolution and frees up your employees to focus on more critical work and handling exceptions.

Increase efficiency without hiring more staff

When you’re dealing with an excess of paperwork, hiring more staff to handle the volume is probably the first solution that comes to mind. Although more staff would indeed solve the problem, it also adds a significant amount in staffing costs to your budget and makes an already resource-heavy process even more so.

Not only will this approach increase costs, but it can also affect workflows and increase the number of errors and misplaced files. From data entry mistakes to misfiling or misplacing important documents, some level of human error is inevitable in any process, and each additional person you add to your grievances and appeals process increases that risk of error.

Outsourcing your mailroom is a great alternative to hiring more staff. With an outsourced mailroom, by the time you receive your documents, they’re already digitized, indexed, and ready to be loaded into your ERP system for automated processing. This means that, combined with workflow automation, each grievance and appeal flows seamlessly between each step of the process without the need for copying, filing, or passing by hand from person to person. Eliminating these time-consuming manual steps with mailroom outsourcing and automation allows you to resolve cases in less time, with smaller operational costs, and with fewer errors.

Simplify audits

Preparing for an audit can be stressful, and it is made more so when paper documents are misfiled or lost, or when your grievances and appeals response time isn’t up to compliance standards. A digital mailroom ensures that grievances and appeals are processed as soon as possible and that each document is digitized, indexed, and stored securely in your ERP system. This means instead of spending hours or days pulling the documents requested by an auditor, you’ll be able to easily locate each one with a simple computer search.

Additionally, storing and managing grievances and appeals documents digitally significantly strengthens the security and confidentiality of your documents. When you outsource mail or email management to a trusted document management partner, your grievances and appeals documents are kept completely secure throughout the entire process: from receipt through scanning, indexing, and delivery to you.

A digital mailroom means less space needed for document storage

Another expense associated with paper-based grievances and appeals processes is storage, especially in larger cities where real estate is at a premium. A 4-drawer filing cabinet could fill up to 17 square feet—this includes the size of the cabinet plus the amount of space required for access. In a place like Manhattan, where the average cost for office space is $73 per square foot, a single filing cabinet would cost you $1,241 a year. Think of how many filing cabinets you’re using to store grievances and appeals documentation. How much money could you be wasting on storage?

On the other hand, a digital mailroom enables you to get rid of paper storage entirely. When you digitize your documents, you store them on a server or in the cloud. It requires no office space at all and provides easier and more secure access—a win all around.

Make your grievances and appeals department best-in-class

No business can afford to be hindered by manual processing inefficiencies. In the healthcare industry especially, it is important that grievances and appeals departments streamline their processes, as swift grievances and appeals resolutions are integral to avoiding penalties for non-compliance.

For example, health plan administrator and homecare agency VNS Health outsourced their mailroom with the goals of creating a best-in-class grievances and appeals unit with rapid resolution times, reducing storage costs, and simplifying audit preparation. After implementing a digital mailroom, documents are scanned and ready for processing within just 24 hours of receipt and the organization saves $6,000 in storage costs annually.

Read the case study to learn more about how a digital mailroom allowed VNS Health to achieve their grievances and appeals goals.