Fearless is expanding our work with the Centers for Medicare and Medicaid Services (CMS) with a new sole-source contract with the Office of Hearings and Inquiries (OHI).
On this contract, we’re helping the Marketplace Appeals Group create a portal for multi-channel communications. The portal will allow for end-to-end automation of the appellant experience, while also allowing the appeals program to obtain real-time data from the initiation of an appeal through its entire lifecycle.
Improving a manual process.
Currently, appellants can only learn about the status of their appeals through a call center or manual processes. But, as Fearless’ Health & Sciences Digital Services Manager Yetty Ibitoye shares, our work will change that.
“This is currently a very manual process, and there’s no easy way for appellants to track the status of appeals,” she said. “The Appellant Portal will provide appellants with easy access to this information. It will make this process much more streamlined and efficient for all users, improving the visibility of appeal statuses and modernizing the overall user experience for both appellants and CMS employees.”
Through the portal, appellants will be able to register, file appeals, upload supporting documents, schedule a hearing, and see the status of their appeals all in one spot. Artificial intelligence (AI) and machine learning (ML) will enable the system to remember where users left off and auto-populate fields for them during return visits. The portal will also support CMS employees, allowing them to request more documentation as needed. This reduces the burden on OHI call centers and support staff, while also shortening the lifecycle of the appeals process.
Reducing the burden on appellants.
Fearless is proud to be a part of this important work. The appeals adjudication process is critical, and it gives appellants the chance to challenge restrictions on coverage — particularly when those decisions could endanger their health. By reducing the burden on appellants and allowing them to track the status of their appeals online, the Appellant Portal will make this process easier and more usable for all.
Customer experience is central to our work at Fearless, so we’re excited to help improve this process for people appealing claims decisions.
“Being denied coverage is a scary thing,” said Yetty. “By giving appellants easy access to timely information on their appeal, we’ll be able to reduce some of the stress and worry that they feel as they await decisions.”
Our work with CMS.
This contract is one of many that Fearless currently has at CMS. We’ve been working with the agency for over 6 years, and we won our first prime contract with CMS in 2018.
We’re thrilled to continue supporting CMS' vision on the Appellant Portal contract.
This announcement was published independently of the Centers for Medicare and Medicaid Services (CMS). This release does not constitute or imply an endorsement by CMS or the United States Government of the product, process, or service, or its producer or provider. The views and opinions expressed in any referenced document do not necessarily state or reflect those of CMS, or the United States Government.