AI-Powered Healthcare Appeals and Grievances Management
Streamline Appeals. Expedite Processing. Improve Outcomes.
Healthcare Appeals and Grievances Management, on ServiceNow
Modernize complex payer workflows with an AI-powered solution built natively on ServiceNow. KeenStack’s Healthcare Appeals and Grievances Management solution automates intake, routing, validation, and audit documentation so health plans can resolve faster, reduce compliance risk, and protect member trust.
Built for U.S. health plans and TPAs, the solution connects seamlessly with existing claims, clinical, and EMPI systems to deliver low-code agility, audit-grade traceability, and measurable ROI.
Addressing Critical Appeals & Grievances Management Challenges
-
Delayed Member Resolution
-
Inconsistent Documentation & Notices
-
Operational Bottlenecks & High Touch Volume
-
Lack of Unified Insights
Manual intake and routing of Appeals and Grievances lead to missed deadlines and prolonged case resolution.
Fragmented systems and manual processes cause variation in notice quality and increase compliance risk.
Appeals and Grievances workflows consume excessive operational resources, diverting focus from strategic improvement.
Siloed data and weak analytics limit visibility into overturns, timeliness, and root-cause trends, hindering continual process improvement.
Revolutionizing Appeals and Grievances Management with Advanced Features
Compliance
Automation
Enforce CMS timeliness rules, generate regulator-grade notices, and maintain a complete audit trail for every case.
Now Assist Case Validation
Now Assist automates Appeals and Grievances validation using knowledge article requirements to ensure compliance and completeness.
AI-Driven Intake and Routing
Automatically capture, classify, and route appeals and grievances across fax, email, and portal channels. The right clock starts on day one.
Document Intelligence for Intake Automation
Extract, process, and automate Appeals and Grievances intake with Document Intelligence for faster, more accurate case creation.
Audit-Ready Documentation
Use standardized templates, automated letters, and dashboards that make audits faster and error-free.
Coordinator Insights Dashboard
Coordinators view insights on Appeals and Grievances via Platform Analytics Dashboard for real-time visibility and performance tracking.
How It Works
Intake and
Validation
AI-powered document intelligence reads and classifies each submission, verifying completeness, identifying duplicates, and confirming representative authorization.
Workflow
Orchestration
Cases route automatically to the correct reviewers with built-in SLA timers and clock controls, ensuring compliance deadlines are met without resets.
Communication and Documentation
Generate acknowledgments, reminders, and determinations from standardized templates, creating regulator-grade letters and audit-ready packets.
Analytics and
Insights
Monitor timeliness, backlog, and overturn trends via the Platform Analytics Dashboard to drive continuous improvement.
Tailored Benefits for Every Role
Automated timelines and notices ensure audit readiness and eliminate CMS deficiencies.
Fewer manual touches, faster resolutions, and fewer external reviews.
Real-time dashboards to track workload, timeliness, and case outcomes.
Built natively on ServiceNow for secure data, low-code agility, and scalable automation.
Built on ServiceNow for Better Results
Together, KeenStack and ServiceNow empower payer organizations to streamline the Appeals and Grievances process, reduce compliance risk, and deliver faster, fairer outcomes for members and providers alike.
Take the Next Step Toward Smarter Appeals and Grievances Management
Experience firsthand how KeenStack’s AI-powered solution accelerates case resolution, strengthens compliance, and builds member trust through intelligent automation and real-time insights.