Appeals & Grievances Management demo
Each appeal rebuilt as a timeline from the first request to the new evidence, with a cited draft decision and the reason a reviewer should look again. 1:15
What the demo shows
A case management solution for health plans that rebuilds each appeal as a cited timeline.
Seven agents sort each letter into appeals and grievances, rebuild the original file, mark what is new, re-test the denial against the medical policy in force on the date of service, and draft a plain-language decision with every reason cited. A physician reviewer who was not part of the first decision signs.
Transcript
- Appeals & Grievances Management rebuilds each health plan appeal as one-sided story.
- Four and five appealed Medicare Advantage denials are overturned, so plans review the same case twice.
- Gloria Trevino appeals a denied spinal fusion.
- Six agents read her letter, the claim, and the records.
- The story reads in order.
- What was asked, what was decided, and what Gloria now says.
- And the original denial is flagged.
- It used the 2026 policy for a 2025 service.
- Under the version in force on December 16th, all four criteria are met.
- 22 other open appeals carry the same mistake.
- One-click retests them all.
- Dr. Whitcomb reads the cited letter and overturns the denial on day 14 of 60.
- Built on Botminds: agents, data, screens, and governance on one platform.
Transcribed from the film’s narration. Captions are on the player.