AI-Powered Appeals and Grievances
focused on Customer Experience, Administrative Savings and Compliance
Using our AI platform and input from Appeals and Grievances subject matter experts, we are seeking a health plan partner to co-launch our AI-Powered Xpress™ Appeals and Grievances in early 2026. Save time with Intake Automation, Clinical Assistant (case summaries for clinician review and approval), a User Assistant (chatbot), predictive intelligence for proactive care, a compliance ready framework, letters, reporting, and universe reports.
Intake Automation
A must-have for anyone who works in Appeals and Grievances, Intake automation saves time and reduces errors.
Intake Automation can be used to intake Appeals or Prior Authorizations and is available as a standalone module or can be added to any Appeals and Grievance system, and is system or platform agnostic.
Clinical Assistant
Clinicians and Medical Directors will appreciate AI-driven clinical summaries, saving them at least 45 minutes per summary. Clinical Assistant summarizes medical chart data and other clinical support and checks them against industry databases and health plan policies, then streamlines the entire process so that a clinician can make a final decision in minutes versus hours. Clinical Assistant is mobile-friendly.
Clinical Assistant is also available as a standalone module which can be added to any Appeals and Grievance system.
“They gave me my wishlist … What vendor does that?”
User Assistant
Avoid errors and accelerate training for new team members in Appeals and Grievances (or in any system that a health plan is using). This chatbot assists in a proactive way based on level of seniority or from machine learning.
Yes, our chatbot is named after our CEO’s former dog, Charlie, a Boxer
Decision Support
Our AI can help improve decision making in Appeals and Grievances, assigning the right work to the right skillsets and prepopulating fields whenever possible.
Grow Together with Our Scalable
Architecture
Xpress™ Appeals and Grievances is suitable for various lines of business e.g., Medicare, Medicaid, Commercial, and various plans e.g., healthcare intermediaries such as TPAs, IPAs, MSOs, and ACOs, with flexible contract and benefit models.
Universe Reports and More
Out of the box, dashboard and real-time reporting including universe reports.
Xpress™ Appeals and Grievance Features
- ›Medicare, Medicaid and Commercial lines of business
- ›Centralized case management
- ›Workflow automation and deadline tracking
- ›CMS/state compliance built in
- ›Audit-ready reporting including Universes
- ›Faster resolutions, better member experience
- ›Clinical Assistant – can be standalone or used with other Appeals and Grievance systems
- ›Case Intake Automation – can be standalone or used with other Appeals and Grievance systems
- ›chatbot assistance (roadmap)
- ›Correspondence Engine
Our Modules - with or without BPO Services
Monument Xpress™ Claims
Xpress™ is a fully loaded core claims processing system but implemented in half the time, and at half the cost.
Learn MoreXpress™ Auth
AI-driven prior auth automation that accelerates approvals, ensures compliance, and improves provider and member experience.
Learn MoreXpress™ Communication
Secure, intelligent fax and communication automation that eliminates manual handling and integrates with plan workflows.
Learn MoreXpress™ Enroll
AI-driven enrollment for Medicare, Medicaid and Commercial lines of business. Connect direct with CMS.
Learn MoreXpress™ Appeals & Grievances
AI driven for more accurate case resolution while ensuring complex regulatory requirements and deadlines.
Learn MoreXpress™ Clinical Assistant
Standalone AI web + mobile tool for clinical decisions. Human-approved for Prior Auth and Clinical Appeals.
Learn MoreXpress™ Intake
Automate and categorizes intake from multiple channels (portal, fax, email, EDI and API), validates eligibility, classifies and routes it forward.
Learn MoreXpress™ Workflow
Configurable web + UI to build and link tasks into workflows. Models improve with time and usage.
Learn More