skip to Main Content

Complaints, Appeals & Grievances (CAG) Suite

Address all member and provider resolutions in one platform

MedHOK offers one of the few solutions that cover Complaints, Appeals, & Grievances in one system. Customers benefit from the most rigorous system in the industry to significantly reduce manual effort and ensure timeliness and compliance. With the MedHOK CAG Suite, clients maximize efficiency with automated workflows, ensure compliance adherence, improve quality scores, and provider and member engagement—ultimately optimizing the healthcare experience for its members.

Solutions

  • Medical Appeals
  • Pharmacy Appeals
  • External Review/Appeals
  • Grievances and Complaints
  • Provider Disputes
  • CMS Complaints Tracking
  • Member Marketing Misrepresentations
  • Quality of Care (Potential Quality Issues)
  • Process Improvement/Root Cause Analysis
  • Regulatory Documentation
  • Pharmacy Quality Alliance and NCQA HEDIS® Drug Adherence Gaps
  • Special Investigations and Fraud Documentation
  • Critical Incident/External Inquiries

Featured Resources

CAG

Medicare Plans Could Face Additional Appeal Scrutiny

A recently released Health and Human Services (HHS) Office of Inspector General (OIG) report could…

Read More

CAG

Will Fax Machines Be Relegated to the Dustbin of History?

Up until a few months ago, I had this decade-old fax machine sitting in my…

Read More

CAG

2019 Policy Rule Means Host of Changes for Medicare Plans

While plans look predominantly at the annual Call Letter for guidance on policy changes, this…

Read More
Back To Top