Appeals Management Services
Faster resolutions. Accurate decisions. Improved member and provider experiences.
Sagility helps health plans manage appeals efficiently and compliantly. Our tech-led workflows and experienced clinical and non-clinical teams reduce backlogs, improve turnaround times, and deliver accurate, audit-ready determinations.
Overview
As part of Sagility’s Claims & Membership Management Suite, our Appeals Management Services support the end-to-end appeals lifecycle — from intake and case setup through clinical review and resolution. We combine automation, standardized workflows, and healthcare expertise to ensure timely, accurate, compliant, and audit-ready appeals processing.
Intake and Case Setup
- Appeals intake across mail, fax, and digital channels
- Case creation and documentation validation
- Timely acknowledgment and tracking
- Regulatory clock management
Review and Determination
- Clinical and non-clinical appeal review
- Medical record retrieval and analysis
- Policy and guidelines application
- Peer-to-peer coordination and escalation support
Resolution and Communication
- Determination, documentation, and audit readiness
- Member and provider communication
- System updates and closure
- Reporting and quality oversight
Decades of Partnership, Performance, and Progress.
Clients stay with Sagility for a reason: deep-domain expertise, measurable outcomes, and a true partnership approach. Purpose-built for healthcare and trusted by the nation’s top health plans and providers, we bring decades of experience and a proven ability to simplify operations and deliver lasting impact.
Straight from the Source
We’re more than a vendor, we’re a partner. Here’s what our clients have to say:
I love working with the Sagility team. They are professional, caring, and always willing to help wherever needed. They deliver high-quality work promptly and consistently exceed expectations.
Senior Payment Integrity Professional,
National Health Plan
They have done an outstanding job serving as our primary point of contact and consistently delivering beyond expectations. They champion our requests and help hold the right stakeholders accountable — including themselves. Sagility is a partner we can rely on for timely execution and transparency. The team is highly capable and consistently meets our requirements.
Director, Partner Operations,
Leading Provider Organization
Sagility consistently meets quality targets and maintains excellent service standards. The team is extremely flexible and ready to assist whenever needed.
Supervisor,
Regional Health Plan
Case Studies
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Insights & Resources
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