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Interactive Customer Communication Management (CCM)

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Interactive Customer Communication Management Solution for Appeals & Grievances Process by Newgen.

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Interactive Customer Communication Management (CCM)

  1. 1. Customer Communication Management <br />Interactive Customer Communication <br />for <br />Appeals & Grievance Process<br />
  2. 2. Process Flow for Appeals & Grievances Process for a Healthcare Provider<br />
  3. 3. Appellant registers his appeals/ grievances via different channels like email, snail mail, fax, telephonic call etc.. <br />Process Flow for Appeals & Grievances Process for a Healthcare Provider<br />
  4. 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 <br />Process Flow for Appeals & Grievances Process for a Healthcare Provider<br />
  5. 5. The Reviewer takes necessary decision on approval or raising an exception for modifications or even discard the appeal with reasoning and remarks.<br />Process Flow for Appeals & Grievances Process for a Healthcare Provider<br />
  6. 6. The committee reviews the Reviewer’s decision and takes the final call on approval of the Appeal. <br />Process Flow for Appeals & Grievances Process for a Healthcare Provider<br />
  7. 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 Solution<br />Process Flow for Appeals & Grievances Process for a Healthcare Provider<br />
  8. 8. Data Entry Agent logs-in to the OmniFlow Screen <br />
  9. 9.
  10. 10. DE Operator initiates a new transaction for every new appeal or grievance entering from different channels.<br />
  11. 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<br />
  12. 12.
  13. 13.
  14. 14. The system validates by a popup to check for the confirmation of the decision <br />
  15. 15. Auto generated mail is triggered to appellant as an acknowledgement of the receipt and initiation of the A&G process<br />
  16. 16. Auto generated html mail from the system<br />Dynamic Data linking of the template to the databases<br />
  17. 17. Reviewer logs in the OmniFlow which is the heart of the Newgen’s CCM Solution for Interactive Communication <br />
  18. 18. Reviewer logs in the OmniFlow which is the heart of the Newgen’s CCM Solution for Interactive Communication <br />
  19. 19. The reviewer selects the corresponding transaction for necessary action execute <br />
  20. 20. Reviewer reviews the data entered corresponding to the appeal by the appellant <br />
  21. 21. Reviewer reviews the data entered corresponding to the appeal by the appellant <br />
  22. 22. Reviewer takes necessary action from the drop down with comments corresponding to it.<br />
  23. 23. Reviewer takes necessary action from the drop down with comments corresponding to it.<br />
  24. 24. The work item is sent back to the reviewer/ pharmalogical appeal department to make necessary changes for the approval. <br />
  25. 25. DE operator / Pharmalogical Appeal Deptt. Operator Logs into the OmniFlow web desktop to make necessary changes in the Appeal<br />
  26. 26. DE operator / Pharmalogical Appeal Deptt. Operator Logs into the OmniFlow web desktop to make necessary changes in the Appeal<br />
  27. 27.
  28. 28. Necessary changes are incorporated by the Pharmalogical Department<br />
  29. 29. Validation to confirm the approval from the Reviewer<br />
  30. 30. Reviewer’s Log In Screen<br />
  31. 31. Reviewer’s Log In Screen<br />
  32. 32. Newgen’s Solution framework enables Extensive search capabilities <br />
  33. 33. Reviewer again reviews and approves the appeal which is further sent to the committee for further approval<br />
  34. 34.
  35. 35. Committee Reviewer logs In with the unique Id and password as provided to users at different stages of the approval cycle<br />
  36. 36. Committee Reviewer logs In with the unique Id and password as provided to users at different stages of the approval cycle<br />
  37. 37.
  38. 38.
  39. 39. Committee Further reviews the appeal which has been approved by the reviewer and takes necessary action<br />
  40. 40.
  41. 41. System generates a final statement – approval letter designed in the Composition Designer Module – part of the Newgen’s CCM solution<br />
  42. 42. Approval letter documents are archived for reference and compliance measures in the Omni Docs ,integral part of the Newgen’s CCM Solution<br />
  43. 43. To view the appeal letters , supervisor logs into the OmniDocs - DMS web interface<br />
  44. 44. Documents are maintained into folder and subfolders as per the Business use cases<br />
  45. 45.
  46. 46. Approval letter corresponding to appeals and the appellant is stored as pdf within the OmniDocs system<br />
  47. 47. The case is closed by sending the confirmation e-mail to the appellant on approval<br />
  48. 48. Thank You<br />Newgen Software Technologies Ltd <br />A-6, Satsang Vihar MargQutab Institutional AreaNew Delhi - 110067, IndiaTel: +91-11-26963571<br />Newgen Software Inc<br />1364 Beverly Rd., Ste. 300McLean, VA 22101, <br />USA <br /> Tel: +1 (703) 749-2855<br />

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