Gorman Health Group | Case IQ
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Bringing clarity to Appeals and Grievances

CaseIQ provides a new way to ensure your cases come to a timely and compliant resolution

Technology

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. Most importantly, every case is subject to a full validation prior to closure, ensuring that all required tasks have been completed.

Workflow

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.

Compliance

CaseIQ was created with CMS compliance in mind.  CaseIQ allows plan users to easily create auto-populating letter templates to generate member letters from case data.  GHG maintains CMS-defined field menus, automated Part C and Part D reporting, and universe generation (based on current year audit protocols), and the organization maintains plan-specific categorizations and menus for the most relevant and actionable reporting.

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Bringing clarity to Appeals and Grievances

 

Designed specifically for Medicare Advantage and Part D organizations by GHG’s subject-matter experts based on years of experience, CaseIQ was created to assist case processors in bringing cases to a timely and compliant resolution.  CaseIQ is a hosted solution, meaning no IT resources are required and implementation can take as little as one week!

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