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MedHOK’s Pharmacy Appeals Solution

Pharmacy Appeals Solution

Solution Overview

MedHOK’s Pharmacy Appeals solution comes out-of-the-box fully CMS-compliant for Medicare lines of business and is easily configurable to achieve compliance for Medicaid, the Exchanges and Commercial business and others. Our cutting-edge platform allows for real-time activity monitoring and promotes a proactive approach to workload management. MedHOK is fully integrated with First Data Bank and Medi-Span for up to the minute FDA and manufacturer guidelines. MedHOK is also capable of integrating with all major PBMs. Our solution includes:

  • A seamless intake process with re-route and forwarding capabilities
  • Automatic member eligibility verification
  • Ability to link appeal to original case information
  • Configurable decision trees aid in decision making process
  • Auto effectuation of approvals in client claim system
  • Automatic correspondence generation based on case status and/or action taken
  • Real-time dashboard reports and alerts for proactive monitoring
  • Pre-built reporting tools as well as business intelligence tools for ad hoc reporting needs

Customers use the solution to:

  • Simplify the appeal process for associates, members and providers
  • Create custom, business-specific workflow rules and routing
  • Remain compliant with federal and state regulations
  • Integrate with IVR and fulfillment vendors to ensure appropriate outreach and communication

Have You Considered …

With Pharmacy Appeals, you may also want to manage related functionalities on one platform to ensure compliance, improve efficiency and productivity, and deliver better quality care. Consider adding these MedHOK solutions:

Medication Therapy Management
Star Quality Measures
Medical Appeals


Pre-configured to be fully compliant day one with Medicare, Medicaid and Commercial/Exchange LOBs


Out-of-the-box best practice workflows to ensure compliance and increase efficiency


Integrates with PBMs to auto effectuate claims for approvals, removing administrative burden

Request a Demo

See How Industry-Leading Payers Use MedHOK’s Pharmacy Appeals Solution

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.

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