Medicare members work with an appeals grievances representative

Transforming the way you manage critical compliance processes with better efficiency, transparency and outcomes

Struggling to meet deadlines for appeals and grievances? With a 24- to 72-hour turn around time in some cases, manual processes can really slow you down. CODY® has a solution for you.

Managed care plans must follow strict rules for how they identify, track, and report all appeals and grievances. Even after a decision is made, additional steps remain in the process: member notification; additional levels of appeal; and aggregate reporting with trends identified and addressed.

Created just for you by the people who understand the challenges
facing Appeals and Grievances, Operations and Compliance, we've built a robust solution with the following features and capabilities:

  • Easy systems integration
  • Dashboards, pre-built and custom reports, and monitoring
  • Automated CMS audit universes
  • Integration with CODY® 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
  • IRE packet automation
Appeals and Grievances

Client Testimonial:

“Please accept our enormous gratitude. Your team spent a lot of time making sure that we had a clear track to fix flaws or issues on a permanent manner and in such a way that it can withstand future CMS scrutiny.”

General Counsel, Midwest Medicare Advantage Plan

The CodySoft® Appeals and Grievances Module® addresses the administrative complexity of the process from intake to aggregate outcome reporting; eliminating manual and inefficient activity, reducing case errors and missed deadlines, and improving compliance.

With the Appeals and Grievances Module®, You Achieve: