Regulators expect organizations involved in healthcare delivery to patients enrolled in federal health insurance programs to have compliance programs capable of receiving, recording, tracking, and addressing complaints and allegations. Compliance officers overseeing these programs must conduct a timely and well-documented reasonable inquiry into any compliance incident or issue involving potential program noncompliance or fraud, waste, and abuse. Noncompliance or fraud, waste, and abuse may be discovered through a hotline or complaint received by mail or electronic means. Organizations need to have the proper mechanisms in place to properly address each one.
Lacking a system to handle complaints and allegations can lead to unwanted publicity, dissatisfied customers, loss of business, and increased oversight from regulators. Others may have a system in place yet still encounter adverse events because of operational weaknesses.
Aridell possesses full-service call center expertise, including intake, prioritization, business risk, triage, trending, and tracking system services. For instance, our subject matter experts are well-experienced in establishing complaint intake operations for healthcare plans and government program integrity operations. This specific experience includes setting up a call center to handle the receipt of complaints and allegations, monitoring call center operations, developing and implementing tracking systems, triaging issues, implementing complaint scoring systems, conducting complaint linking analysis, researching complaints, and investigating complaints.
Aridell’s capabilities include:
Designing and Establishing Full-Service Complaint Intake Operations
Designing and Establishing Tracking Systems
Call Center Operations
Risk Assessment Tools
Complaint Triaging and Risk Scoring
Complaint Research and Investigation
Complaint Trending and Pattern Identification
Aridell Associates, LLC