Calculate the ROI of Automating Appeals and Grievances
See how much your health plan could save by reducing manual work, improving compliance, accelerating resolution times, and lowering A&G related call volume.
Enter your annual appeals and grievances volume to receive an instant estimate of potential savings with the Smart Communications Solution Suite.
Appeals and grievances are among the most labor-intensive and compliance-sensitive processes for health plans. Manual intake, routing, communications, and audit preparation can drive up operational costs and increase regulatory risk. This calculator estimates the financial impact of modernizing your A&G process with automation.
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How Many Appeals and Grievances Do You Process Each Year?
Disclaimer*This calculator uses industry benchmarks for operational savings, labor productivity, compliance risk reduction, call deflection, and audit readiness to estimate potential value.
How does the Appeals and Grievances Calculator Work?
The calculator estimates potential savings based on your annual appeals and grievances volume and industry benchmarks for operational efficiency, labor productivity, compliance risk reduction, call deflection, and audit-readiness costs. Results are intended as directional estimates and may vary by organization.
How can automation improve appeals and grievance processes?
Automation can help health plans streamline intake, route cases automatically, track compliance deadlines, generate compliant communications, reduce manual effort, and create audit-ready records throughout the A&G lifecycle.
What solutions support appeals and grievance modernization?
Modern A&G programs typically combine digital intake, workflow orchestration, compliant communications, and audit-ready archiving to improve efficiency, compliance, and member experience. The solutions that make up the Conversation Cloud provide address all of this and compliment case management systems such as Salesforce and Pega.
What areas of the A&G process are included in this calculator?
The calculator focuses on the A&G processes that the Conversation Cloud can directly impact, namely: streamlining digital case intake, standardizing case correspondence for case workers, maximizing digital delivery channels for case-related communications, providing clear and proactive status updates to case stakeholders, and providing audit-ready records.
What assumptions are used in this calculator?
Our calculations use industry benchmark data for average cost per case ($45), average labor hours spent on each case (two), the all-in hourly labor cost ($40), the amount of annual A&G-related fines and penalties ($250,000), the average number of calls per case (1.2), the average cost per call ($7), and the average audit and legal costs per year ($150,000). To those we apply an automation savings factor (35%) and a fines/penalty reduction factor (50%). These savings/reductions are typical of organizations that have automated their appeals and grievances processes.
Can I change the assumptions?
Certainly! You have the flexibility to customize the assumptions for your ROI calculations, and we encourage it. To receive a detailed ROI analysis tailored to your unique needs, please schedule a custom demo.
Disclaimer
This calculator is provided for informational purposes only and does not constitute financial, legal, compliance, or business advice. We recommend that you obtain independent advice in respect of such ROI. This model is provided as a rough approximation of future financial performance based on the information you provide. The results presented by this calculator are hypothetical and may not reflect the actual ROI. SmartComms SC Limited and its affiliates are not responsible for the content, results, or accuracy of the information on the calculators. SmartComms SC Limited and its affiliates are not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information provided by these tools. SmartComms SC Limited and its affiliates are not responsible for any human or mechanical errors or omissions. The results of the calculations are not a promise or guarantee of a customer’s eligibility or terms for a specific product or service.