As a result of an increased volume of claims appeals, the Centers for Medicare and Medicaid Services (CMS) had to streamline the review process in order to meet the demand. To do this, CMS partnered with Maximus to improve operations, appeal policies, and application development to simplify the process for consumers through an Eligibility Appeals Operations Support (EAOS) program.
One of the changes made was the development of the CMS Virtual Private Cloud (VPC), which served as the backbone for digital transformation efforts. These transformation efforts provided CMS with the tools the agency needed to embrace data-driven decision making and decrease the time it took to process appeals. By focusing on human-centered design, CMS was able to drive efficiency, optimize customer experience, and transform its service delivery capabilities.
To learn more about the approach taken by the CMS and its partner, Maximus, download the full case study.