Join Us at HLTH 2024! Find us at kiosk #3370-26 in the Club Startup pavilion at The Venetian Expo (Level 2).
Appeals & Grievance Automation
Built on CareAssistant.ai – the Agentic AI platform from CareInsight
Transform Your
Appeals & Grievance Operations
Combine LLM reasoning, deterministic rules, and deep healthcare context to deliver fast, compliant, member-first outcomes.
| Challenge | Traditional Workflow | With CareInsight |
|---|---|---|
| CMS compliance (ODAG & CDAG) | Manual checklists and late‑night audits | Built‑in rule engine auto‑validates every step and flags risks in real time |
| High touch‑time per case | 45‑60 min average analyst effort | Agentic AI drafts 90% of determinations, cutting touch‑time to < 12 min |
| Member experience | Long call‑backs, opaque status | Omnichannel updates + conversational AI keep members informed 24/7 |
| Operational visibility | Siloed spreadsheets | Live dashboards with SLA clocks, root‑cause clusters, and audit‑ready export |
Key Capabilities
Agentic Task Orchestration
Autonomous case‑agents read the intake, request missing data, draft letters, queue peer review, and close the loop with members and providers.
Context-Aware LLM Reasoning
Healthcare‑tuned models cite benefit language, national guidelines, and CMS memos to generate evidence‑backed determinations.
Smart Intake & Routing
From email to EDI, the platform understands the intent and routes the case to the right queue—automatically.
Audit‑Ready Compliance Engine
42 CFR 422/423 Subpart M timelines, dynamic timers, auto-archived artifacts, and prebuilt notice templates keep you audit-ready.
Real-Time Analytics & Root-Cause Insights
Dashboards show trends, overturns, SLA breaches, and denial drivers—so you act before CMS ever asks.
Low-Code Configuration
Drag‑and‑drop workflows, reusable templates, and versioned rules. No vendor ticket needed.
Ready to modernize your A&G operations?
Let’s put CareAssistant.ai to work.
