Case Study: CROWD 2.0
March 6, 2026CMS Significantly Improves Medicare Appeals Processing Time Using Salesforce
The Case, Hearings, and Appeals Modernization Project (CHAMP) transformed Medicare appeals processing, enabling the Office of Hearings (OH) to process over $40 billion in appeals through digital innovation
Overview
The Cases, Hearings, and Appeals Modernization Project (CHAMP) was conceived to transform how the Office of Hearings (OH) manages Medicare appeals. OH plans, directs, and coordinates the administration and delivery of fair and independent Provider Reimbursement Review Board (PRRB), Medicare Geographic Classification Review Board (MGCRB), Medicare Advantage Risk Adjustment Data Validation (MA RADV), and CMS Hearing Officer (HOM) proceedings. CHAMP tackled the legacy paper and mail-based appeals process, delivering a public sector digital transformation which enabled OH to process over $40 billion in appeals.
Faced with a rapidly accelerating need and a fragmented appeals process that lacked transparency, the Centers for Medicare & Medicaid Services (CMS) had developed a foundational system under the CHAMP initiative called the Office of Hearings Case and Document Management System (OH CDMS). But the initial framework fell short, creating additional obstacles to the processing of appeals.
In August 2018, CMS partnered with Index Analytics LLC to enhance the OH CDMS framework into a fully operational digitized Medicare appeals process. As part of this transformation, Index digitized over four million legacy case pages, allowing for full automation of what had been paper-based processes.
With the CHAMP partnership extended into 2030, Index Analytics continues to support and enhance the application using Agile SAFe development, allowing rapid response to legislative changes and user needs and ensuring the platform evolves alongside CMS's priorities.
Key Challenges
The Solution
Simultaneously supporting immediate business needs, design challenges, and long-term system goals, Index rapidly engineered the digital transformation using Salesforce Service Cloud and Experience Cloud to deliver a secure, end-to-end case management application that:
- Enhanced centralized case intake, assignment, scheduling, and resolution.
- Enabled real-time visibility into case status using Stage Management.
- Promoted staff collaboration and workload transparency using Chatter and Notes features.
- Automated notifications and letter templates, streamlining workflows.
- Empowered data-driven decisions with custom dashboards and reports.
- Aligned with federal regulations using built-in security, 508 compliance, and audit logging.
Key Benefits
Automated Workflows
Automating intake through resolution, including key decision points, approval chains, and notifications, allowing immediate access to documents
System Availability
During COVID, appeal requests were electronically filed and the appeals process moved forward efficiently as compared to the delays that would have resulted from manual, in-person processing
Help Desk
Ongoing Tier 1 and Tier 2 support to 1,200 users — common issues are tracked and resolved through education and creation of Standard Operating Procedures, reducing the need for OH engagement
User Portal
Direct access to the electronic case management system for ease of submitting appeal requests, notifications, and transparency of case status
Integrated Reports
Integrated dashboards for OH leadership and staff that provide visibility to monitor performance and identify trends, enabling data-driven decision making to drive policy improvements
Training
Comprehensive, step-by-step training materials, external user manuals, and Knowledge Base Articles accessible within the system
User Direct Entry
Eliminates time-consuming data entry and minimizes potential data entry errors
Compliance
Validations built into the system ensure accurate and complete appeal data. Automatic flags on the cases highlight untimely findings bringing attention to cases that do not meet compliance
Measurable Results
Reduction in average days to send Case Acknowledgement Letters (from 32.75 days in 2019 to 6.67 days in 2025)
Increase in issues with disposition dates within one year (from 61.60% in 2019 to 72.63% in 2024)
MGCRB Decision Turnaround: Despite case volume increasing from 348 cases (2018) to 705 cases (2025), the average days to issue decision letters decreased from 172 days to 149 days—a 13.3% reduction.
The case review functionality facilitates streamlined access to all required case documentation for OH including Medicare Administrative Contractors; Appeals Support Contractors; and Provider, Parent, and Representative Organizations. This has led to improved user satisfaction scores from CMS and stakeholders, consistent compliance with records management and policy standards, and a dramatic improvement in visibility into caseloads and bottlenecks.
OH CDMS has evolved to include additional modules and integrations, including document automation, reporting enhancements, a wealth of mineable data, a library of KBAs, and expanded intake channels. Measurable comparisons of the legacy process to OH CDMS demonstrate equivalent or drastic improvements in efficiency.
What Our Partners Say
I just wrapped up my presentation to the American Health Law Association conference and wanted to share that we received a bunch of very positive responses regarding the users’ interactions with the help desk – great to work with, prompt, responsive, friendly. Thank you for representing OH well on the front lines.
At the beginning of this period of performance the contractor inherited a system with significant flaws and incomplete development but was able to implement solutions that quickly allowed structural improvements to stabilize the system. The contractor has been eager to offer proactive support in areas such as training, suggesting standard Salesforce features and outside the box system improvements.
On our CMS Cases, Hearings, and Appeals Modernization Project (CHAMP) Digitization of Case Documents (DOCD) contract, Index processed more than four million pages of legal paper documents and transformed this unstructured legacy data into digitized appeal documents. These documents were mined for critical structured data elements that were captured and placed into a Salesforce application. This resulted in the creation of over 83,000 documents and 152,000 records in production. These records and scans were organized and structured into each appeal as if system users digitally submitted them today.
Significant code updates were made that allowed enhancements to the case management system to be implemented without taking the system offline.
Index was proactive in delivering accurate performance metrics that reflected the status of the project implementation for a case management system (the operations and maintenance element of the subject task order). The developed code was of exceptional quality with only minor issues that were immediately resolved.
Digital Transformation by the Numbers
Pages of legacy documents digitized
Documents created in production
Records organized and structured
Conclusion
The CMS Index partnership under CHAMP is a standout example of public sector digital transformation done right and a model for how thoughtful Salesforce customization can facilitate operations. Through Agile collaboration, innovation, and user-centric design, OH now handles complex caseloads with clarity, speed, and transparency – a leap forward in federal appeals management. In recognition of this effort, the project was awarded the FedHealthIT Innovation Award in 2019. Index Analytics will continue to support OH and OH CDMS through CHAMP into July 2030.
The program demonstrates that federal modernization efforts can be both cost-effective and provide robust functionality. OH CDMS not only saves time and resources but also increased transparency and adaptability during a period of heightened demand, including during the COVID-19 pandemic. The CMS and Index Analytics collaboration model under CHAMP stands as a replicable example of how technology solutions can fundamentally improve government efficiency and services when aligned with mission goals.
Disclaimer: This communication does not represent the official views, policies, or positions of the Centers for Medicare & Medicaid Services (CMS) or the U.S. Department of Health and Human Services (HHS). References to CMS programs, systems, or activities are provided for informational purposes only and do not constitute endorsement, sponsorship, or approval by CMS or HHS of any products, services, vendors, or organizations mentioned. Any performance metrics, cost figures, or outcomes described are the responsibility of the authors and have not been independently validated by CMS.