Medical Appeals Solution
MedHOK’s Medical Appeals feature is a pre-configured workflow solution for processing and tracking medical appeals from a member or provider. The system-defined workflow ensures that cases are processed consistently and correspondence is automatically triggered and attached to the original case.
Customers use this solution to:
- Take-in and process medical appeals of denied authorizations or claims payment in a timely manner
- Track cases sent to Independent Review Entity (IRE), IRE decisions and effectuation dates
- Communicate with external appeals entities and ensure any overturn decisions are implemented
- Track dates to internal Service Level Agreements (SLAs)
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Why do more than half of MedHOK’s clients use the Medical Appeals solution?
Our clients represent some of the nation’s largest and most prestigious health plans, PBMs, Specialty Pharmacies, and other payers. See for yourself why they rely on the MedHOK Unified Payer Platform for Medical Appeals. Please complete the form and let us know which capabilities you would like to see. One of our demo specialists will contact you to schedule your custom demo.