In the News
Performance Clinical Systems Releases Game-Changing Functionality for Appeals and Grievances Processes with Health Plans
The company’s Symphony platform streamlines A&G processes by providing timely cloud-based collaboration across all stakeholders.
San Francisco, Calif. December 29, 2017– Performance Clinical Systems, the leader in rapidly-deployable technologies for clinical workflow improvement, today released next-generation functionality for its care management platform, Symphony, that extends role-based guidance, business rules and reporting capabilities to the appeals and grievances (A&G) processes for health plans. This latest release uniquely ensures disputes concerning medical and behavioral health services are handled competently, expeditiously and equitably for all members and providers.
“Member appeal documentation requires review by appeal coordinators, often in conjunction with a wide mix of medical directors, managers, and specialty advisors, who may be located in different locations,” said Brian O’Neill, CEO of Performance Clinical Systems. “It’s critical for all involved in the A&G collaborative process to have easy access to relevant information and documentation in a timely manner. Clients tell us that the intuitiveness of the Symphony platform is what sets it apart from traditional legacy systems,” he added.
Symphony consolidates all A&G activity into one seamless cloud-based system that can be easily accessed from virtually any setting (plan, provider, member), enabling the capture of all required data to meet regulatory compliance. Additionally, Symphony’s configurable business rules drive automation for notifications, reminders, follow-up tasks, and required correspondence.
“With major fines being levied against some health plans recently, our clients have told us it’s critical to offer the most up-to-date status of each case as it traverses the system,” said Waseem Khan, Performance Clinical’s Vice President of Operations. “We specifically designed Symphony’s latest functionality to leverage its cloud-based access and storage that creates unparalleled visibility for reporting, auditing, performance management, follow-up inquiries, and decision status,” he noted.
Symphony eliminates the need for multiple systems and antiquated, insecure paper-based processes. It provides comprehensive reporting on all A&G activity to meet specific organizational and regulatory requirements.
About Performance Clinical Systems
Performance Clinical Systems is a privately held healthcare information technology company based in San Francisco, California. Founded by two physicians, its cloud-based workflow accelerator platform, Symphony™, proactively manages patient outreach and encounters across various roles and clinical settings within team-based care models. Algorithms tailor “on the fly” workflows based on case-specific care needs, prior patient encounters, payer contract requirements, and the specific role of a care team member. This approach enables efficient and scalable patient engagement models which are highly personalized. Additionally, Symphony ensures regulatory-compliant engagement and creates an electronic trail for care and contract compliance reporting. For more information, visit www.performanceclinical.com.
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Performance Clinical Systems
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