Interactive Customer Communication Management (CCM)
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The document describes the process flow for appeals and grievances for a healthcare provider using Newgen's Customer Communication Management solution. The process involves appellants registering appeals/grievances via various channels. A data entry agent then enters the details into Newgen's CCM solution, triggering an auto-generated acknowledgment email. A reviewer makes an approval/exception decision and the committee makes the final call. An approval letter is generated and sent to the appellant if approved.
Interactive Customer Communication Management (CCM)
- 1. Customer Communication Management Interactive Customer Communication for Appeals & Grievance Process
- 2. Process Flow for Appeals & Grievances Process for a Healthcare Provider
- 3. Appellant registers his appeals/ grievances via different channels like email, snail mail, fax, telephonic call etc.. Process Flow for Appeals & Grievances Process for a Healthcare Provider
- 4. 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
- 5. 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
- 6. 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
- 7. Approval Letter generated over the predefined templates is sent to the appellant and also archived into OmniDocs –DMS , integrated part of Newgen’s CCM SolutionProcess Flow for Appeals & Grievances Process for a Healthcare Provider
- 8. Data Entry Agent logs-in to the OmniFlow Screen
- 10. DE Operator initiates a new transaction for every new appeal or grievance entering from different channels.
- 11. 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
- 14. The system validates by a popup to check for the confirmation of the decision
- 15. Auto generated mail is triggered to appellant as an acknowledgement of the receipt and initiation of the A&G process
- 16. Auto generated html mail from the systemDynamic Data linking of the template to the databases
- 17. Reviewer logs in the OmniFlow which is the heart of the Newgen’s CCM Solution for Interactive Communication
- 18. Reviewer logs in the OmniFlow which is the heart of the Newgen’s CCM Solution for Interactive Communication
- 19. The reviewer selects the corresponding transaction for necessary action execute
- 20. Reviewer reviews the data entered corresponding to the appeal by the appellant
- 21. Reviewer reviews the data entered corresponding to the appeal by the appellant
- 22. Reviewer takes necessary action from the drop down with comments corresponding to it.
- 23. Reviewer takes necessary action from the drop down with comments corresponding to it.
- 24. The work item is sent back to the reviewer/ pharmalogical appeal department to make necessary changes for the approval.
- 25. DE operator / Pharmalogical Appeal Deptt. Operator Logs into the OmniFlow web desktop to make necessary changes in the Appeal
- 26. DE operator / Pharmalogical Appeal Deptt. Operator Logs into the OmniFlow web desktop to make necessary changes in the Appeal
- 28. Necessary changes are incorporated by the Pharmalogical Department
- 29. Validation to confirm the approval from the Reviewer
- 30. Reviewer’s Log In Screen
- 31. Reviewer’s Log In Screen
- 32. Newgen’s Solution framework enables Extensive search capabilities
- 33. Reviewer again reviews and approves the appeal which is further sent to the committee for further approval
- 35. Committee Reviewer logs In with the unique Id and password as provided to users at different stages of the approval cycle
- 36. Committee Reviewer logs In with the unique Id and password as provided to users at different stages of the approval cycle
- 39. Committee Further reviews the appeal which has been approved by the reviewer and takes necessary action
- 41. System generates a final statement – approval letter designed in the Composition Designer Module – part of the Newgen’s CCM solution
- 42. Approval letter documents are archived for reference and compliance measures in the Omni Docs ,integral part of the Newgen’s CCM Solution
- 43. To view the appeal letters , supervisor logs into the OmniDocs - DMS web interface
- 44. Documents are maintained into folder and subfolders as per the Business use cases
- 46. Approval letter corresponding to appeals and the appellant is stored as pdf within the OmniDocs system
- 47. The case is closed by sending the confirmation e-mail to the appellant on approval
- 48. Thank YouNewgen Software Technologies Ltd A-6, Satsang Vihar MargQutab Institutional AreaNew Delhi - 110067, IndiaTel: +91-11-26963571Newgen Software Inc1364 Beverly Rd., Ste. 300McLean, VA 22101, USA Tel: +1 (703) 749-2855