CODY® Launches CodySoft Appeals and Grievances Module

The new CodySoft Module is part of an enterprise-wide solution to help health plans manage critical aspects of CMS compliance and reporting.

Appeals and GrievancesTAMPA, Fla. (May 5, 2020) – CODY®, a Tampa, Fla.-based technology provider and consulting firm, has announced a new addition to its CodySoft® toolkit for health plans. The Appeals and Grievances Module® is part of an interconnected suite of Medicare Advantage compliance and operations tools designed to help health plans manage critical compliance processes with greater efficiency, transparency and outcomes.

“It can be a struggle for health plan operations and compliance departments to meet deadlines for appeals and grievances within stringent and ever-changing CMS timeframes,” said Deb Mabari, CEO of CODY. “Often, CMS requires health plans to deliver complex data in only 24 to 72 hours, which can be extremely challenging if the plan is using only manual processes.”

The new Appeals and Grievances Module addresses administrative complexity from case intake to aggregate outcome reporting. It eliminates manual and inefficient activity, reduces case errors and missed deadlines and improves compliance. The module simplifies the most challenging aspects of Appeals and Grievances management for health plans, including:

  • Easy systems integration
  • Dashboards, pre-built and custom reports, and monitoring
  • Automated CMS audit universes
  • Integration with CODY’s HPMS Memo Module®
  • Root cause analysis and trending
  • Automated letter generation
  • Data validation and data integrity rules
  • Comprehensive quality review process
  • Workflow and audit trail
  • Case completion and effectuation rules
  • Independent Review Entity (IRE) packet automation

In addition, the Appeals and Grievances Module increases productivity through automated alerts, scheduling, task creation and monitoring, and by centralizing all regulatory references and resources. The dynamic compliance dashboard and real-time insight and monitoring provide enhanced visibility. Data integrity and validation is ensured through Appointment of Representative (AOR) and Waiver of Liability (WOL) automated check and validation processes, and a built-in QA Review for every case before closure. Regulatory compliance and reporting are possible through quality monitoring, scheduled regulatory report creation and audit preparation.

The Appeals and Grievances Module seamlessly interfaces with other CodySoft modules, including the Policy and Procedures Module®, Compliance Correspondence Module®, HPMS Memo Module®, Risk Management Module®, Compliance Reporting Calendar Module®, and Incident Management Module®.

CODY is the only software provider to offer such a robust solution to health plan compliance and operations departments. Its nearest competitor offers only four of the twelve features and capabilities available in the CodySoft Appeals and Grievances Module.

CODY drew upon its more than a decade of experience working with more than 60 government-funded, commercial and ACA health plans across 45 states and Puerto Rico to create the architecture of the Appeals and Grievances Module.

“Development of the Appeals and Grievances Module is another validation that CODY is on the forefront of providing tech-enabled services that allow health plans to focus on better serving their members,” said Mabari.

The new module has already been adopted by CODY health plan clients who report that it is a powerful and effective way to follow the strict requirements to identify, track and report all appeals and grievances to CMS.

About CODY: CODY works with more than 60 government-funded, commercial and ACA health plans across 45 states and Puerto Rico. We help health plans maximize efficiencies and strategically integrate operations by streamlining marketing communications and improving regulatory compliance. Our proprietary suite of software, CodySoft®, is specifically designed for health plans.