CMS-mandated timelines for grievances and appeals are not getting more forgiving, and most health plans are still managing this critical workflow across disconnected systems. In our recent webinar with ServiceNow, we explored what it takes to bring G&A onto a single platform, from intake to resolution.
Meet the Speakers
- Elevsis Delgadillo: SVP of Customer Success, KeenStack
- Milind Shah: Head of Payer Industry, ServiceNow
- Vishakha Sant: Global Industry Technology Partnerships, Healthcare Payer, ServiceNow
The Challenge
Health plans are managing grievances and appeals across fragmented systems, leading to missed deadlines, notice-quality errors, and audit trails that do not hold up under CMS scrutiny.
Key Takeaways
- Most G&A failures start at intake. Incomplete data, wrong clocks, and manual handoffs create downstream compliance risk before a case is even assigned.
- OIG data shows MA plans overturned roughly 75% of appealed denials, meaning most initial decisions are fixable upstream with better workflows.
- A single platform consolidates intake, investigation, decision tracking, and regulatory reporting to reduce resolution times and eliminate audit gaps.
- AI-driven automation handles acknowledgment and determination letters, compliance clock enforcement, and duplicate prevention without manual intervention.
- Real-time dashboards give compliance and operations leaders live visibility into backlog, on-time performance, and escalation risk.
Why It Matters
Every day a health plan runs G&A on disconnected systems is a day closer to an enforcement action. The right platform does not just reduce manual work. It makes compliance the default.
Our Solution
KeenStack’s AI-Powered Healthcare Appeals & Grievances Management application is available now on the ServiceNow Store. Built natively on ServiceNow, it helps U.S. health plans automate and orchestrate the full A&G process with regulator-grade audit trails that withstand CMS scrutiny.
Learn more on our Appeals & Grievances solution page.