Ensure prompt resolution, dispatch, and administration of your members’ appeals and grievances while adhering to state-level and Center for Medicare and Medicaid Services (CMS) guidelines. Streamline the end-to-end process, from initiation to offering prompt resolutions. Leverage a rule-driven business engine, intuitive workflows, document management, and AI capabilities to optimize resources, expedite case processing, and enhance decision-making. Additionally, auto-summarize data, regardless of volume, freeing up time for individuals to address more complex needs. Expedite resolution of claims denials, ensuring swift action and minimizing delays. Enhance member services by leveraging Gen AI technology to improve the quality and efficiency of interactions.
Features of Newgen’s Digital Appeals and Grievances Solution
Efficient Case Management
Detect and flag duplicates while identifying past cases for fraud prevention and quicker resolutions. Optimize resources’ bandwidth with automated case distribution, manage escalations, and prioritize cases. Extend case timelines as needed for thorough investigations and giving resolutions.
Automatic Document Generation
Generate automated correspondences, including acknowledgment and resolution letters, ensuring adherence to regulatory mandates. Compile case summary documents, incorporating case artifacts and relevant data.
Documents Insights through GenAI
Extract critical data and create precise summaries from documents (medical records and EOBs) instantly for informed decision-making. Classify documents accurately while using the built-in AI-driven algorithms
360-degree Case Visibility
Comprehensive dashboard to conveniently manage cases. Get periodic status reports and member case updates while keeping business managers duly informed.
Audit Documentation and Packet Generation
Generate downloadable case packets for internal/external audits and CMS compliance. Customize reports to meet CMS requirements and get insightful analytics.
Unified System for Information Capture
Capture and create new case information from various sources for efficient processing of cases. Fetch eligibility details of members and providers from the core system
Accurate Decision and Assessment
Use AI/ML algorithms to support decision-making and enhance efficiency. Integrate clinical/MD reviews into the process for accurate case assessment.
Robust Integration
Integrate with external portals for streamlined data exchange and workflows. Ensure data accuracy and compliance through intelligent validation mechanisms.
Business Benefits of Newgen’s Digital Appeals and Grievances Solution
Optimized Processes
Eliminate manual hand-offs by automating processes from case initiation to resolution. Minimize the scope for unnecessary delays or errors in the process to develop much-needed trust among members and providers
Better Compliance
Leverage comprehensive audit-trails for enterprise-wide audits. Monitor case milestones and estimated resolution timelines to maintain consistency and comply with CMS regulations
Enhanced Member & Provider Engagement
Gain a 360-degree view of member and provider information to offer timely resolutions, thereby enhancing their overall experience
Faster Resolutions
Witness better routing of cases with options to manage escalations and case exceptions via workflow and auto-prioritization of standard and expedited cases
Improved Visibility
Leverage an intuitive dashboard to manage cases in an error-free manner. Keep case managers apprised of the ongoing status of cases to enhance overall visibility in the process
