+1 844 476 6900
Appeals, Grievances and Complaint Tracking Module
Appeals, Grievances and Complaint Tracking Module
Appeals & Grievances is comprehensive Medicare Advantage Appeals, Grievances and Complaint Tracking Module for creation and management of all types of Medicare Appeals and Grievances including Part B drugs, Part C, Part D, and a Complaint Tracking Module (CTM)
Why Appeals and Grievances solution is preferred by Health Plans
Automatic calculations
Automatic Due Date/Due Time calculation based on the case type and priority
Centralized database
All case data, including generated letters and attached documentation, are stored in a centralized database
Detailed Case History
Maintained from the moment a case is opened until it is closed
Customizable
Customizable dropdown menus and screen layouts
Easily export Dashboards
Easily export dashboards and Reports to Excel spreadsheets or PDF documents
Reducing operational costs
Ability to attach documents and medical records helps to eliminate paper files, reducing operational costs
Why Appeals and Grievances solution is preferred by Health Plans
Automatic calculations
Automatic Due Date/Due Time calculation based on the case type and priority
All case data, including
All case data, including generated letters and attached documentation, are stored in a centralized database
Detailed Case History
Maintained from the moment a case is opened until it is closed
Customizable
Customizable dropdown menus and screen layouts
Easily export Dashboards
Easily export dashboards and Reports to Excel spreadsheets or PDF documents
Reducing operational costs
Ability to attach documents and medical records helps to eliminate paper files, reducing operational costs
Features at a glance
Support for all required CMS case types. Supports Standard or Expedited time frames, Pre-Service or Post-Service
Reduced data entry through integration with Enrollment, Claims, and Authorization systems based on Claim Number or Authorization Number
If no Claim Number or Authorization Number, pull Member and Provider data from Member House and Provider Villa systems
Full integration with Utilization Management System (Unified Portal)
Round Robin case assignment based on case type
Analysts can upload and attach documentation supporting the Appeal or Grievance request, including medical records
Due date computation basis the case type and priority
Email alerts when cases reach their Due Date
User decisions are recorded for audit purpose
Comprehensive case history and notes are maintained
Includes all required CMS Reports including Part C and Part D and Universe Reports
Real-time dashboards containing graphic displays
All required correspondence is generated and sent to members, authorized representatives, and providers, with letters in English or Spanish, with all letter templates approved by CMS
Manages escalation of Denied cases to the IRE or higher levels
Manages the effectuation of Approved and Overturned cases
Download BrochureWhy choose MIRRA's®Appeals and Grievances Solution?
Mirra's Appeals and Grievances system enables Health Plans to identify, process, and track all CMS appeals and grievances to ensure compliance with CMS requirements. The A&G system includes all Universe reports required by CMS, plus other reports including those for timelines and an adhoc report feature, a powerful search engine that can be used to create user defined reports which can be recalled and run at any time.
Reviews & Testimonials
Mirra collaborated well with our operations and compliance teams to successfully design and implement a system that was innovative, efficient, and compliant with all Medicare and Florida Medicaid guidelines and requirements all within the scope of our required timeline.
We greatly benefitted from the Mirra Project Management Team’s regular communication with Stakeholders through monthly meetings and recurring weekly breakout-focused calls, which were geared towards troubleshooting and goal alignment. Mirra was able to quickly maneuver and adapt their systems to our needs, resulting in successful implementation and go-live. Mirra continues to support our compliant operation and growth in the ever-changing healthcare industry rapidly and effectively updating their systems with new Medicare and Florida Medicaid rates and guidelines to ensure seamless compliance and efficiency. I have absolutely no reservation in recommending their systems to any Payer searching for improvement in their operational efficiency."
NANCY GAREAUCEO of Ultimate Health Plans
Book Demo Today
Personalized Demo Tailored to Your Organization's Needs