Governance, Risk, and Regulatory Compliance

Prevent fraud, ensure compliance, and reduce risk.

Protect your patients and members by ensuring your organization meets industry compliance standards on the Appian HIPAA-compliant and HITRUST-certified cloud.

Better track, manage, and report on compliance requirements.

Bexley Health implemented a solution with Appian in less than a week to ensure compliance within the NHS across Primary Care and the wider local health & social care system.

 
  • Automate your member appeals
    Expedite processes and provide a clear explanation of benefits to your members.
  • Simple exception handling
    Easily handle and automate both commonplace appeals and exceptions to provide faster customer service.
  • A single source for claims visibility
    Run a seamless complaints, appeals, and grievances process to provide members the service they expect.
  • A single system for contract management
    Reduce errors and risk with a single staff login for organization wide contracting. 
  • Referral management that makes compliance simple
    Ensure alignment with anti-kickback and anti-bribery laws to stay within contractual parameters.
  • Save time and money while improving accuracy
    Achieve a real-time, unified view of physicians and cash flow while consolidating data silos.

 

  • Stop needless financial loss before it starts
    A solution to detect fraud before it happens and support case investigations. 
  • Streamline internal and external collaboration on fraud
    Easy coordination between internal departments and law enforcement for faster fraud detection and resolution.
  • A unified view of all in-progress FWA Cases
    We provide solutions with the urgency you need for faster financial recoveries and resolutions
  • Ensure effective clinical quality reviews from start to finish
    Track clinical quality measures and ensure they’re being properly carried out.
  • Reduce readmission rates and increase patient satisfaction
    Help providers spend less time on admin duties and more time on patient care.
  • Unify multiple systems to create a single source of truth
    We make it possible for  all services to be tracked in one place for easier management and better patient care.

Request a Demo

Learn how Appian can help health plans expedite complaints or appeals for increased member satisfaction.