Casemend builds software for healthcare operations teams managing regulated case workflows — provider enrollment, compliance reviews, audit responses, and the adjudication backlogs that pile up when manual tracking breaks down. Built by a team with direct experience inside CMS.
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The Platform
Thousands of concurrent cases. Overlapping federal and state regulatory frameworks. Turnaround time requirements that vary by jurisdiction. Documentation needs that change based on case type. A chain of reviewers who each need visibility at different stages. That's what healthcare operations teams are actually managing every day.
Casemend replaces the spreadsheets, shared inboxes, and manual tracking that most organizations still rely on. The platform manages case intake and assignment, applies jurisdiction-specific routing rules, tracks regulatory deadlines against actual turnaround times, and generates the audit trail documentation that CMS and state regulators expect during reviews.
From initial intake through determination and appeals, every case stage is tracked with full audit trails. Workflows are configurable per case type — enrollment applications, compliance reviews, and grievance cases each follow their own adjudication path.
Federal and state regulators set hard turnaround time requirements. The system calculates deadlines based on case type, jurisdiction, and regulatory program, flags cases approaching their TAT limits, and triggers escalation before you miss a filing window.
Every action, decision, and status change is logged with timestamps and user attribution. When auditors ask for a case history, it's already there.
Our Background
Casemend's founding team built technology within CMS — the Centers for Medicare & Medicaid Services. Provider enrollment processing systems. Fraud detection infrastructure. Systems that managed initial applications, revalidation cycles, and deactivation workflows under federal turnaround requirements, coordinating referrals and corrective action tracking across multiple agencies.
We know what happens when a provider enrollment case sits in a hold queue for three weeks because the assignment logic doesn't differentiate between an initial application and a revalidation with a change of information. We've written the corrective action plans that result when audit trails have gaps. We built Casemend because we spent years working around those exact problems.
Medicare Administrative Contractor coordination. Federal program integrity reviews. The gap between what a regulation says on paper and how it actually gets implemented at the operational level. That's what we know, and that's what Casemend is built on.
Capabilities
A Medicare enrollment application and a state Medicaid compliance review follow different rules, different timelines, and different documentation requirements. Cases route automatically based on jurisdiction, program type, and your organization's internal assignment rules.
When a case pends for missing documentation, a third-party verification, or an external regulatory review, it enters a hold queue with its compliance clock tolled. The system tracks hold reasons, pend aging, and the conditions that trigger re-activation — so nothing falls through the cracks while the clock is stopped.
Regulatory turnaround requirements, contractual SLAs, and internal processing benchmarks are tracked against actual case aging. Dashboards show which cases are approaching TAT limits, which reviewers are carrying overdue work, and where adjudication bottlenecks are forming across your caseload.
A single case might touch internal reviewers, the provider's credentialing team, a Medicare Administrative Contractor, and your compliance department. Role-based access controls ensure each stakeholder sees their piece of the case — determination status, requested documents, pending actions — without exposing what they shouldn't see.
Security & Compliance
Protected health information flows through every case in the system. Casemend is architected for HIPAA-regulated environments from the ground up — not retrofitted after the fact. Our security controls and audit capabilities reflect what federal healthcare programs actually require during compliance reviews.
Administrative, physical, and technical safeguards for protected health information.
Independent audit of security controls, availability, and confidentiality over time.
All data encrypted at rest. PHI and PII never stored in plaintext.
All data encrypted in transit between clients, services, and storage.