The customer is a multi-state healthcare payer and offers both Medicare and Medicaid plans

Day-to-Day Challenges

New regulations and manual processes for managing Appeals and Grievances were posing a huge challenge to the organization. The absence of a centralized repository, lack of systems for auto-generation of various letters, inability to validate duplicate cases and long turnaround times were symptoms of a Health Plan process gone wrong. The Health Plan realized that there was an urgent need to streamline and automate their Appeals and Grievances management process.

Newgen was chosen for the job because of our expertise in Intelligent Business Process Management (BPM), Enterprise Content Management (ECM) and Customer Communication Management (CCM) based Healthcare solutions.

Timely and effective resolution of appeals and grievances

Newgen deployed its appeals and grievances management solution based on its Intelligent Business Process Management platform integrated with its Enterprise Content Management system.

The solution enabled the Health Plan to resolve member requests within specified timelines, reduce operational inefficiencies and demonstrate compliance, leading to improved member satisfaction.

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