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

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Why 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

DJ OLIVERExecutive Director of Liberty Medicare Advantage

"In the process of looking for a Third Party Administrator, we identified Mirra as a candidate. After meeting with the team and understanding their experience, systems, and processes, we knew we had a great partnership opportunity. Mirra was able to transition our data quickly and effectively. Our teams work very closely to ensure successful operations of the health plan."

NANCY GAREAUCEO of Ultimate Health Plans

"In 2021, Ultimate Health Plans (UHP) partnered with Mirra Health Care (Mirra) to develop a software platform to support processing Claims, Customer Service, Eligibility, Enrollment, Premium Billing, Encounter Processing and a Provider Portal for our Medicare Advantage Plans. 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."

DJ OLIVERExecutive Director of Liberty Medicare Advantage

NANCY GAREAUCEO of Ultimate Health Plans

DJ OLIVERExecutive Director of Liberty Medicare Advantage

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