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98% Improvement in CMS Compliance     |     90% Reduction in Error Rate     |     50% Increase in Report Delivery Levels    |    50% Enhancement in Adherence to Due Dates     |     60% Improvement in External Agency Collaboration     |     75% Rise in Data Validation     |     98% Improvement in CMS Compliance     |     90% Reduction in Error Rate     |     50% Increase in Report Delivery Levels    |    50% Enhancement in Adherence to Due Dates     |     60% Improvement in External Agency Collaboration     |     75% Rise in Data Validation     |     98% Improvement in CMS Compliance     |     90% Reduction in Error Rate     |     50% Increase in Report Delivery Levels    |    50% Enhancement in Adherence to Due Dates     |     60% Improvement in External Agency Collaboration     |     75% Rise in Data Validation     |     98% Improvement in CMS Compliance     |     90% Reduction in Error Rate     |     50% Increase in Report Delivery Levels    |    50% Enhancement in Adherence to Due Dates     |     60% Improvement in External Agency Collaboration     |     75% Rise in Data Validation     |     98% Improvement in CMS Compliance     |     90% Reduction in Error Rate     |     50% Increase in Report Delivery Levels    |    50% Enhancement in Adherence to Due Dates     |     60% Improvement in External Agency Collaboration     |     75% Rise in Data Validation     |     98% Improvement in CMS Compliance     |     90% Reduction in Error Rate     |     50% Increase in Report Delivery Levels    |    50% Enhancement in Adherence to Due Dates     |     60% Improvement in External Agency Collaboration     |     75% Rise in Data Validation     |    

“Newgen’s Appeals Solution has simplified our entire processes, improved accuracy, and strengthened compliance, helping us achieve new levels of efficiency.”

– Vice President of Member Services & Appeals, A Leading Health Plan

Built for Payers. Designed for Members

Leverage our Complaints, Appeals, & Grievances Suite to build trust with a member-first approach.

Efficient Case Management

Detect/flag duplicates to prevent fraud and speed up resolutions. Automate case allocation to optimize bandwidth and manage escalations. Ensure robust integration with document management capabilities for smoother workflows, improved accuracy, and faster claims.

Unified Information Capture and Processing

Consolidate data capture from multiple sources for efficiency. Fetch eligibility details of members and providers in one place. Leverage GenAI to extract critical data, classify records, and generate instant summaries for informed decision-making.

Automated Communications, Audit Documentation, and Packet Generation

Generate automated correspondences to ensure adherence to regulatory mandates. Compile case summaries with relevant data and artifacts. Create downloadable case packets for internal/external audits and CMS compliance.

360-degree Case Visibility, Decision Support, and Integration

Access a comprehensive dashboard to manage cases and get periodic updates. Leverage AI/ML to augment decision-making efficiency. Integrate clinical/MD reviews for accurate case assessment. Ensure robust integrations with external portals for smooth data exchange.

Efficient Case Management

Detect/flag duplicates to prevent fraud and speed up resolutions. Automate case allocation to optimize bandwidth and manage escalations. Ensure robust integration with document management capabilities for smoother workflows, improved accuracy, and faster claims.

Unified Information Capture and Processing

Consolidate data capture from multiple sources for efficiency. Fetch eligibility details of members and providers in one place. Leverage GenAI to extract critical data, classify records, and generate instant summaries for informed decision-making.

Automated Communications, Audit Documentation, and Packet Generation

Generate automated correspondences to ensure adherence to regulatory mandates. Compile case summaries with relevant data and artifacts. Create downloadable case packets for internal/external audits and CMS compliance.

360-degree Case Visibility, Decision Support, and Integration

Access a comprehensive dashboard to manage cases and get periodic updates. Leverage AI/ML to augment decision-making efficiency. Integrate clinical/MD reviews for accurate case assessment. Ensure robust integrations with external portals for smooth data exchange.

Learn What Newgen’s Appeals Solution Can Do for You

Unified Intake and Case Management

Capture and process new cases from all intake channels, including web portals, mailrooms, and faxes, into a single, unified system. Integrate across all sources seamlessly to ensure comprehensive case management, improving accuracy and efficiency throughout the appeals process.

Intelligent Automation for Case Processing

Pull eligibility, claim, and authorization details automatically from the core system to streamline case management. Categorize cases intelligently, detect redundancies, and route cases efficiently with AI-driven tools. Predict case types accurately as sufficient details are extracted, ensuring grievances are correctly routed or disputes are triaged for smooth resolution.

Smart Assignment and Collaboration

Assign cases based on coordinator expertise, prioritizing and managing escalations. Ensure collaboration across teams (clinical nurses, medical doctors, and claims admins) with a unified platform for easy case reviews and redirects. Ensure accountability with automated case histories and research tracking, thereby enhancing audit readiness and efficiency.

Advanced Analytics and Oversight

Gain complete visibility with dashboards and reports tailored to operational and compliance needs. Track productivity, identify bottlenecks, and ensure adherence to regulatory requirements. Generate insights for workforce planning, compliance audits, and business intelligence, driving continuous improvement across workflows.

Automated Communications and Notifications

Generate CMS-compliant correspondence automatically, managing letters, faxes, and emails through omnichannel communication. Ensure timely notifications and escalate delays proactively. Automate written and oral communication tracking for improved member and provider engagement.

Quality Assurance and Audit Preparedness

Evaluate work accuracy and coordinator efficiency with advanced QA sampling algorithms. Use detailed checklists and scores to assess performance. Ensure audit readiness with comprehensive case packets and tools to address regulatory requirements, minimizing risks and improving compliance outcomes.

Unified Intake and Case Management

Capture and process new cases from all intake channels, including web portals, mailrooms, and faxes, into a single, unified system. Integrate across all sources seamlessly to ensure comprehensive case management, improving accuracy and efficiency throughout the appeals process.

Intelligent Automation for Case Processing

Pull eligibility, claim, and authorization details automatically from the core system to streamline case management. Categorize cases intelligently, detect redundancies, and route cases efficiently with AI-driven tools. Predict case types accurately as sufficient details are extracted, ensuring grievances are correctly routed or disputes are triaged for smooth resolution.

Smart Assignment and Collaboration

Assign cases based on coordinator expertise, prioritizing and managing escalations. Ensure collaboration across teams (clinical nurses, medical doctors, and claims admins) with a unified platform for easy case reviews and redirects. Ensure accountability with automated case histories and research tracking, thereby enhancing audit readiness and efficiency.

Advanced Analytics and Oversight

Gain complete visibility with dashboards and reports tailored to operational and compliance needs. Track productivity, identify bottlenecks, and ensure adherence to regulatory requirements. Generate insights for workforce planning, compliance audits, and business intelligence, driving continuous improvement across workflows.

Automated Communications and Notifications

Generate CMS-compliant correspondence automatically, managing letters, faxes, and emails through omnichannel communication. Ensure timely notifications and escalate delays proactively. Automate written and oral communication tracking for improved member and provider engagement.

Quality Assurance and Audit Preparedness

Evaluate work accuracy and coordinator efficiency with advanced QA sampling algorithms. Use detailed checklists and scores to assess performance. Ensure audit readiness with comprehensive case packets and tools to address regulatory requirements, minimizing risks and improving compliance outcomes.

Explore Other Solutions for the Payer-Member Journey

Member Portal

Empower members with instant access to information, enhancing convenience and engagement

Enrollment Case Management

Optimize enrollment with an automated, customized system while improving accuracy

Premium Billing

Simplify end-to-end billing process while enhancing precision and overall accuracy

Complaints to Medicare

Fast-track the resolution of Medicare complaints, delivering better outcomes and maintaining strict regulatory adherence

Grievances and Complaints

Manage grievances and complaints that comply with federal regulations and accreditation standards

External Reviews

Optimize external reviews while ensuring transparency and maximizing operational excellence throughout the process

Sales and Retention

Boost sales and retention with an AI-driven, automated system while gaining real-time insights into the process

Find Your Winning Strategy with Newgen

Schedule a Demo to See Newgen’s Payer-Member Solution in Action

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