Affinitē Appeals & Grievances (AG)

Automate Compliance and Empower Your Team

Real-time visibility, audit-ready accuracy, and smarter workflows – all in one configurable solution.

Audit-proof compliance. Streamlined operations.
Better member experiences.

Appeals and grievances are one of the most scrutinized compliance areas for health plans. Manual processes, siloed systems, and inconsistent reporting put organizations at risk of costly penalties – and frustrated members. Affinitē AG changes the game with automation, real-time oversight, and audit-ready accuracy.

Leverage a Configurable A&G Solution that Evolves with Constant Regulation Changes

Instant Compliance with Real-Time Visibility

Stop scrambling when audit season arrives. Affinitē AG brings full end-to-end oversight, flagging issues the moment they occur so your team can act decisively, not reactively.

Save Time - and Money - with Intelligent Automation

Ditch manual processes. From automated workflows and activity tracking to one-click CMS reporting, Affinitē AG slashes hours of paperwork and hundreds of thousands in operational costs.

Built for Complexity, Designed for Simplicity

Compliance rules evolve fast - but your tools don’t have to lag behind. Affinitē AG is fully configurable, offering self-serve reports, executive dashboards, mobile access, and pre-close auditing to keep you compliant and agile.

Collaborate Seamlessly Across All Functions

Appeals and grievances aren’t siloed—and neither should your response be. With cross-department tasking and a complete, 360° member view, Affinitē AG ensures faster resolutions and consistent care coordination

The Affinitē Advantage

For over a decade, health plans have trusted Vital Data Technology to simplify compliance and quality reporting. With Affinitē AG, payer organizations can eliminate compliance risk, lower costs, and focus on what matters most: improving member care.

The Executive Dashboard

Comprised of high-level charts and graphs designed to provide leadership with a snapshot of the overall health of the department; they should have drill-down capabilities so an executive can focus in on a particular case causing issues.

Operational Reporting

These reports help manage day-to-day operations, typically viewed by the Appeals & Grievances manager/supervisor, and help leadership assess the quantity and quality metrics from their team.

Universes

CMS regulators review these to determine if a health plan is properly managing the cases as well as its members; there should be plenty of front-end rules and logic in an Appeals & Grievances system to prevent inputs that are unacceptable for the universes.

Regulatory Reporting

In a similar way as the universes, the front-end rules and logic should produce pristine and high-quality regulatory reports (e.g., put in a date range and with one click, generate a universe).

Ad-Hoc Reports

Once the system is live, health plans should be able to create, save and run reports using an ad-hoc reporting tool; this provides needed flexibility when CMS changes its requirements on a report.

The best Appeals & Grievances technology providers will help plans to capture data and document it in a way that mitigates the risk of audit penalties.

A&G reporting should be configurable, real-time, proactive, and available with the touch of a button.

Affinitē Appeals & Grievances (AG)