Digital. Dynamic. Dependable.
Accelerate Enrollment, Reduce Errors to Elevate Member Experience
Your enrollment rules are unique. Your platform should be too. NewgenONE Member Enrollment & Management provides an enrollment framework with ready capabilities that can be configured and extended around your plan’s products, regulatory requirements, business rules, workflows, and operational priorities. Leverage AI-driven automation, intelligent rules engines, and low-code agility to reduce errors, minimize rejections, and ensure CMS compliance. Empower health plans with faster enrolments, real-time visibility, and a fully digital, scalable experience.
Member Enrollment and Management: Buy All-in-one Pack or Choose an Individual Solution
Medicare Member Enrollment
Configure a CMS-aware Medicare enrollment engine. Support OEC, paper and portal intake, BEQ validation, CMS batch submission, DTRR & Monthly reconciliation, DSNP coordination, PCP assignment, trigger-based actions, member communications, and audit-ready reporting
Medicaid Member Enrollment
Configure Medicaid enrollment workflows for state-specific EDI transactions, eligibility rules, exception handling, multi-state compliance needs, member communications, and end-to-end audit visibility
Exchange/Commercial Member Enrollment
Streamline Exchange and Commercial enrollment across EDI 834 intake, portal integration, eligibility validation, binder/payment dependencies, effectuated transactions, correspondence, and compliance workflows
Member Servicing Request
Capture, route, track, and resolve enrollment-related service requests across channels, giving members, brokers, and operations teams better visibility from request to resolution
Member Communications & Fulfillment
Automate welcome kits, ID cards, enrollment confirmations, regulatory notices, and multilingual member communications across print and digital channels for Medicare, Medicaid, and Exchange enrollment
Medicare Member Enrollment
Configure a CMS-aware Medicare enrollment engine. Support OEC, paper and portal intake, BEQ validation, CMS batch submission, DTRR & Monthly reconciliation, DSNP coordination, PCP assignment, trigger-based actions, member communications, and audit-ready reporting
Medicaid Member Enrollment
Configure Medicaid enrollment workflows for state-specific EDI transactions, eligibility rules, exception handling, multi-state compliance needs, member communications, and end-to-end audit visibility
Exchange/Commercial Member Enrollment
Streamline Exchange and Commercial enrollment across EDI 834 intake, portal integration, eligibility validation, binder/payment dependencies, effectuated transactions, correspondence, and compliance workflows
Member Servicing Request
Capture, route, track, and resolve enrollment-related service requests across channels, giving members, brokers, and operations teams better visibility from request to resolution
Member Communications & Fulfillment
Automate welcome kits, ID cards, enrollment confirmations, regulatory notices, and multilingual member communications across print and digital channels for Medicare, Medicaid, and Exchange enrollment
Learn What NewgenONE Member Enrollment & Management Solution Can Do for You
Intelligent Enrollment Processing
Identify enrollment intent, perform delta detection-distinguish adds, changes, retroactive updates, reinstatements, terminations, and route application through the appropriate workflow path
Built-in Eligibility & Compliance Checks
Apply eligibility validation, delta detection, and configurable business-rule checks to incoming enrollment transactions, identifying errors before they become compliance problems
Dual-eligibility and Multi-program Coordination
Detect and manage Medicare, Medicaid, D-SNP, and other dual-eligible scenarios while maintaining coordinated member information across programs
Member Communications & Fulfillment
Automate acknowledgments, RFI, enrollment confirmations, welcome kits, ID cards, regulatory notices, and multilingual member communications across print and digital channels
Unified Intake
Capture enrollment requests the moment they arrive from member/ broker portals, OCR-scanned paper applications, EDI feeds, CMS files. with automatic data enrichment and document capture
Automated CMS & State Transaction Management
Automate enrollment submissions, response-file processing, reconciliation, exception handling, and regulator-initiated actions with visibility across the enrollment lifecycle
Audit Readiness & Operational Visibility
Track decisions, validations, documents, communications, user actions, and system updates to support CMS and state audits and improve operational transparency
Built to Adapt & Scale
Configure workflows, business rules, communications, dashboards, and exception handling with evolving regulatory, business, and growth needs
Intelligent Enrollment Processing
Identify enrollment intent, perform delta detection-distinguish adds, changes, retroactive updates, reinstatements, terminations, and route application through the appropriate workflow path
Built-in Eligibility & Compliance Checks
Apply eligibility validation, delta detection, and configurable business-rule checks to incoming enrollment transactions, identifying errors before they become compliance problems
Dual-eligibility and Multi-program Coordination
Detect and manage Medicare, Medicaid, D-SNP, and other dual-eligible scenarios while maintaining coordinated member information across programs
Member Communications & Fulfillment
Automate acknowledgments, RFI, enrollment confirmations, welcome kits, ID cards, regulatory notices, and multilingual member communications across print and digital channels
Unified Intake
Capture enrollment requests the moment they arrive from member/ broker portals, OCR-scanned paper applications, EDI feeds, CMS files. with automatic data enrichment and document capture
Automated CMS & State Transaction Management
Automate enrollment submissions, response-file processing, reconciliation, exception handling, and regulator-initiated actions with visibility across the enrollment lifecycle
Audit Readiness & Operational Visibility
Track decisions, validations, documents, communications, user actions, and system updates to support CMS and state audits and improve operational transparency
Built to Adapt & Scale
Configure workflows, business rules, communications, dashboards, and exception handling with evolving regulatory, business, and growth needs
Recommended for You
Orchestrate for an Intelligent Enterprise, Now!
Explore all the ways you can tap into orchestration to transform your business for the era of intelligence!
