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Use caseUC0243

Catch a health plan's missed complaint clock

A member calls or writes, and whoever takes the contact has seconds to decide if it's a quick question or something that starts a clock. This app reads the whole contact and files it on the track the plan's own written rules require.

For the contact centreHealthcare

Why it matters

Today's manual process, and the same job with the app

A contact centre at a health plan, filing every call, letter and message it receives.

✕Today's manual process

1Listen to the call or read the message, and judge from memory what kind of contact it is.
2File it on a track informal question, tracked case, grievance or appeal, based on a quick read.
3Close it out if it sounds like a simple question, the contact ends there.
4A missed complaint never starts its clock, and nobody finds out until an audit.
Every contact filed from memory

✓With the app

1The contact is read in full, in the member's own words.
2The track is filed against the plan's own written rules, not a guess.
3The deciding sentence is shown the exact line that set the track.
4A missed clock is caught before it reaches an audit.
Every contact checked against written rules

See it work

One real case: what the app reads, step by step

A member says it was probably nothing about a late payment; the app reads dissatisfaction and files it as a grievance.

Catch a health plan's missed complaint clockReference appBuilt to be shaped to your process
  1. 1What they said first small talk before the real issue: best time to call, paperwork in hand.
  2. 2What the app read dissatisfaction, filed on the grievance track.
  3. 3The line that decides it left waiting so long they assumed the plan had given up.
  4. 4The rule it cites CT-3: expressed dissatisfaction is a grievance.
  5. 5The outcome a grievance clock starts on this contact.

For engineers

How it is built, and how we measured it

All fourteen steps of the build are written up, from the business case to running it in your own environment.

Kit overview →
1 of 40regulatory clocks missedmeasured in 06 Evals →
0 of 26wrong low filings copiedmeasured in 06 Evals →
25 of 26low filings correctedmeasured in 06 Evals →
0.12¢to check one contactmeasured in 07 Unit cost →

The build, step by step

14 steps

Make it yours

What you see is a reference app. We shape it to how you work.

Every part of it is built to change, and none of it means starting over.

Your rulesYour own four tracks and the written policy that decides which contact goes where.
Your recordsYour own contact notes, call summaries and the register you already keep on each member.
Your systemsReads from your contact centre log; filed contacts route into your own case system.
Your screensThe fields, tracks and wording your compliance team already uses.

Want this for your team?

Talk to us

We can run this on your own contact records, against your own written policy, inside your environment.

Talk to us →
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