Interactive Customer Communication Management (CCM)

Customer Communication Management

Interactive Customer Communication for

Appeals & Grievance Process

Process Flow for Appeals & Grievances Process for a Healthcare Provider

Process Flow for Appeals & Grievances Process for a Healthcare Provider

Appellant registers his appeals/ grievances via different channels like email, snail mail, fax, telephonic call etc..

Auto generated acknowledgement mail is sent to the appellant soon after the Data Entry Agent registers the appeal into Newgen’s CCM solution for Interactive Communication

Process Flow for Appeals & Grievances Process for a Healthcare Provider

The Reviewer takes necessary decision on approval or raising an exception for modifications or even discard the appeal with reasoning and remarks.

Process Flow for Appeals & Grievances Process for a Healthcare Provider

The committee reviews the Reviewer’s decision and takes the final call on approval of the Appeal.

Process Flow for Appeals & Grievances Process for a Healthcare Provider

Approval Letter generated over the predefined templates is sent to the appellant and also archived into OmniDocs –DMS , integrated part of Newgen’s CCM Solution

Process Flow for Appeals & Grievances Process for a Healthcare Provider

Data Entry Agent logs-in to the OmniFlow Screen

DE Operator initiates a new transaction for every new appeal or grievance entering from different channels.

The operator keys in details corresponding to the Appeal on the form created in Newgen's form designer - OmniForm , within the Newgen’s CCM framework

The system validates by a popup to check for the confirmation of the decision

Auto generated mail is triggered to appellant as an acknowledgement of the receipt and initiation of the A&G process

Auto generated html mail from the system

Dynamic Data linking of the template to the databases

Reviewer logs in the OmniFlow which is the heart of the Newgen’s CCM Solution for Interactive Communication

Reviewer logs in the OmniFlow which is the heart of the Newgen’s CCM Solution for Interactive Communication

The reviewer selects the corresponding transaction for necessary action execute

Reviewer reviews the data entered corresponding to the appeal by the appellant

Reviewer reviews the data entered corresponding to the appeal by the appellant

Reviewer takes necessary action from the drop down with comments corresponding to it.

Reviewer takes necessary action from the drop down with comments corresponding to it.

The work item is sent back to the reviewer/ pharmalogical appeal department to make necessary changes for the approval.

DE operator / Pharmalogical Appeal Deptt. Operator Logs into the OmniFlow web desktop to make necessary changes in the Appeal

DE operator / Pharmalogical Appeal Deptt. Operator Logs into the OmniFlow web desktop to make necessary changes in the Appeal

Necessary changes are incorporated by the Pharmalogical Department

Validation to confirm the approval from the Reviewer

Reviewer’s Log In Screen

Reviewer’s Log In Screen

Newgen’s Solution framework enables Extensive search capabilities

Reviewer again reviews and approves the appeal which is further sent to the

committee for further approval

Committee Reviewer logs In with the unique Id and password as provided to users at different stages of

the approval cycle

Committee Reviewer logs In with the unique Id and password as provided to users at different stages of

the approval cycle

Committee Further reviews the appeal which has been approved by the reviewer

and takes necessary action

System generates a final statement – approval letter designed in the Composition Designer Module – part

of the Newgen’s CCM solution

Approval letter documents are archived for reference and compliance measures in the Omni Docs ,integral

part of the Newgen’s CCM Solution

To view the appeal letters , supervisor logs into the OmniDocs - DMS web interface

Documents are maintained into folder and subfolders as per the Business use cases

Approval letter corresponding to appeals and the appellant is stored as pdf within the OmniDocs system

The case is closed by sending the confirmation e-mail to the appellant on approval

Thank You

Newgen Software Technologies Ltd

A-6, Satsang Vihar MargQutab Institutional AreaNew Delhi - 110067, IndiaTel: +91-11-26963571

Newgen Software Inc

1364 Beverly Rd., Ste. 300McLean, VA 22101, USA Tel: +1 (703) 749-2855