WASHINGTON – November 13, 2014. Gorman Health Group, LLC (GHG), the leading consulting firm and solutions provider in government health care programs, announced the launch of its appeals and grievances software, CaseIQ™. The first of its kind, CaseIQ™ not only captures all the data points needed to categorize, work and report coverage disputes and complaints; it also guides users through the appropriate processing of each case, minimizing the risk of non-compliance due to user error.

All the Centers for Medicare & Medicaid Services (CMS) requirements for processing Part C and D appeals and grievances are included in CaseIQ™, and maintained by GHG on an ongoing basis. As a hosted solution, updates and enhancements are included in the annual licensing fee with no additional upgrade fees – ever.

“Since the inception of Medicare Advantage, appeals and grievances have been a consistent struggle for plans, and an area of intense focus for CMS audits,” explained April Fleming, GHG’s Senior Vice President of Products. “Due to high member impact, the ability to compliantly and efficiently manage these cases is essential for every health plan, but more than half of all plans audited are still unable to process cases timely and appropriately according to a recent CMS memo.”

CaseIQ™ captures key information related to intake, processing, categorization, determinations, and higher appeals or re-openings, to process cases according to CMS’s complex and detailed requirements. CaseIQ’s™ user-friendly forms assist the case processor by automatically enabling or disabling sections according to their applicability for the current case type and entered information.  Due date, status and next steps are automatically calculated by the system and displayed for prioritization; while integrated notes, document attachments, and case routing allow users to create and work comprehensive case files simultaneously. Most importantly, every case is subject to a full validation prior to closure, ensuring that all required tasks have been completed.

“We are thrilled to launch our first-of-its-kind software to streamline the appeals and grievances process for plans and their members,” said John Gorman, GHG’s Founder and Executive Chairman. “To regulators, appeals represent the beneficiary’s Constitutional right to due process in coverage denials. In our nearly 20 years of assisting health plans in Medicare, appeals and grievances have always been the #1 risk area, and will stay that way if you don’t have the right tools in place. Through CaseIQ™, plans can finally achieve timely and compliant resolution of appeals and grievances, better meet beneficiary needs, and stay off CMS’s radar.”


About Gorman Health Group | Gorman Health Group is a national health care professional services and software company staffed by subject matter experts, former health plan executives, and seasoned regulators. For nearly 20 years, hundreds of clients serving millions of beneficiaries have leveraged the strategic counsel and technology solutions of GHG to maintain compliant operations, improve market position, and advance growth objectives. GHG’s solutions continually evolve to meet the needs of our clients. Learn more at www.gormanhealthgroup.com.