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MedHOK's Medical Appeals Solution
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Medical Appeals Solution

Solution Overview

MedHOK’s Medical Appeals feature is a pre-configured workflow solution for processing and tracking medical appeals from a member or provider. The system-defined workflow ensures that cases are processed consistently and correspondence is automatically triggered and attached to the original case.

Customers use this solution to:

  • Take-in and process medical appeals of denied authorizations or claims payment in a timely manner
  • Track cases sent to Independent Review Entity (IRE), IRE decisions and effectuation dates
  • Communicate with external appeals entities and ensure any overturn decisions are implemented
  • Track dates to internal Service Level Agreements (SLAs)

Have You Considered ...


With Medical Appeals, you may also want to manage related functionalities on one platform to ensure compliance, improve efficiency and productivity, and deliver better quality care. Consider adding these MedHOK solutions:

Download Product Spec Sheet

100% Compliant with Medicare, Medicaid, Commercial and Exchange

Ensure compliance with MedHOK's Unified Payer Platform, built from the ground up to be compliant from day one

Increase Star Ratings

Compliant and consistent handling of appeals, grievances and complaints can result in improved Star ratings, provider relationships, and member satisfaction

Based on Industry Best Practices

Automatic workflows based on industry best practices ensure cases are processed consistently and correspondence is triggered automatically

Request a Demo

Why do more than half of MedHOK's clients use the Medical Appeals solution?

Our clients represent some of the nation's largest and most prestigious health plans, PBMs, Specialty Pharmacies, and other payers. See for yourself why they rely on the MedHOK Unified Payer Platform for Medical Appeals. Please complete the form and let us know which capabilities you would like to see.  One of our demo specialists will contact you to schedule your custom demo.

Medical Appeals Demo Request