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40–60% Dropout Claim Recovery    |    Recover 85% of Rejected Claims Revenue    |    45% Faster Claims Turnaround    |    38% Reduction in Pended Claim Backlog    |    42% Improvement in First Pass Resolution Rates    |    35% Drop in Manual Rework Hours    |    50% Increase in Provider Query Response Speed    |    40% Boost in Claim Data Accuracy    |    40–60% Dropout Claim Recovery    |    Recover 85% of Rejected Claims Revenue    |    45% Faster Claims Turnaround    |    38% Reduction in Pended Claim Backlog    |    42% Improvement in First Pass Resolution Rates    |    35% Drop in Manual Rework Hours    |    50% Increase in Provider Query Response Speed    |    40% Boost in Claim Data Accuracy    |    40–60% Dropout Claim Recovery    |    Recover 85% of Rejected Claims Revenue    |    45% Faster Claims Turnaround    |    38% Reduction in Pended Claim Backlog    |    42% Improvement in First Pass Resolution Rates    |    35% Drop in Manual Rework Hours    |    50% Increase in Provider Query Response Speed    |    40% Boost in Claim Data Accuracy    |    40–60% Dropout Claim Recovery    |    Recover 85% of Rejected Claims Revenue    |    45% Faster Claims Turnaround    |    38% Reduction in Pended Claim Backlog    |    42% Improvement in First Pass Resolution Rates    |    35% Drop in Manual Rework Hours    |    50% Increase in Provider Query Response Speed    |    40% Boost in Claim Data Accuracy    |    40–60% Dropout Claim Recovery    |    Recover 85% of Rejected Claims Revenue    |    45% Faster Claims Turnaround    |    38% Reduction in Pended Claim Backlog    |    42% Improvement in First Pass Resolution Rates    |    35% Drop in Manual Rework Hours    |    50% Increase in Provider Query Response Speed    |    40% Boost in Claim Data Accuracy    |    40–60% Dropout Claim Recovery    |    Recover 85% of Rejected Claims Revenue    |    45% Faster Claims Turnaround    |    38% Reduction in Pended Claim Backlog    |    42% Improvement in First Pass Resolution Rates    |    35% Drop in Manual Rework Hours    |    50% Increase in Provider Query Response Speed    |    40% Boost in Claim Data Accuracy    |   

Newgen’s ClaimsONE Suite restored trust through transparency and automation. By streamlining repairs, appeals, and disputes, we now deliver faster, more accurate outcomes while maximizing operational efficiency.

Chief Operations Officer, Top-tier Health Plan, US

Newgen’s ClaimsONE Suite: Buy All-in-one Pack or Choose an Individual Solution
optimized-process

Claims Repair

Automatically fix and resubmit pended claims, minimizing manual effort, accelerating resolution, and ensuring accuracy at scale

Member and Provider Service Inquiries

Ensure smooth processing of inquiries while enhancing member and provider experience

Provider Dispute Resolution

Enhance your payer-provider interactions by optimizing claim disputes and inquiries

Member & Provider Appeals

Simplify the complete process while staying compliant, enhancing efficiency, and improving stakeholder collaboration

Grievances & Complaints

Manage grievances and complaints that comply with federal regulations and accreditation standards
higher-compliance

External Review

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

Member & Provider Service Portal

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

Learn What Newgen’s ClaimsONE Suite Can Do for You

Intelligent Mailroom, Case Assignment, and Enrichment

Simplify correspondence management with ECM integration and AI-driven document processing and content intelligence. Automatically assign cases based on the expertise and priority, while handling disputes, payment reviews, and returned checks. Populate claims and authorization details from core systems to minimize manual effort and enhance accuracy

Duplicate Check, Case Collaborations, and Redirects

Detect duplicate entries to prevent fraud and redundancy. Collaborate across departments, redirect cases seamlessly, and ensure a unified view of investigation and resolution details for complex claims

Detailed Reporting, Visibility, and Analytics

Generate productivity and compliance reports to identify bottlenecks, streamline workflows, and ensure adherence with regulatory needs. Leverage a comprehensive dashboard, offering periodic updates and AI-driven insights from past decisions for consistent outcomes

Automated Case Processing, Correspondence, and Advanced Search

Generate compliant letters automatically for single or bulk cases, eliminating manual intervention and ensuring accuracy. Maintain comprehensive records of decisions, notes, and exceptions. Identify patterns in provider behavior to improve accountability and optimize future processes. Locate any case instantly. Use a quick search to track its lifecycle or an advanced search to filter by specific details

optimized-process

Claims Repair

Streamline claim correction and resubmission for pended, rejected, and drop-out claims. Utilize AI-driven bulk error fixing capabilities and seamless workflow reintegration to turn rejects into paid claims, often within hours

Grievance and Complaints

Automate the end-to-end grievance and complaints process for fast, accurate, and responsive resolutions. Process each complaint individually for classification, tracking, and resolution using best-practice messaging and granular reporting to enable effective root-cause analysis. Leverage GenAI and intelligent classification for advanced document and message processing, ensuring consistent data capture, accurate summaries, and reduced misinterpretation risks for every case

Appeals Solution

clinical reviews, medical record retrieval, and power of attorney outreach. Optimize workflows to ensure expedited appeals handling, robust document processing, and compliance with evolving regulations. Use advanced reporting and decision support drive operational efficiency, accuracy, and positive outcomes for payers, members, and providers

Payment Integrity – Fraud, Waste & Abuse

Verify coding accuracy, medical necessity, and contract compliance before payment. Prevent errors and recover overpayments via systematic audits and review checkpoints. Stop external leakage for invalid payments and employ automated detection of fraud, waste, and abuse using real-time pattern recognition and fraud scoring. Ensure payment accuracy, operational efficiency, and robust protection against improper healthcare payments

Intelligent Mailroom, Case Assignment, and Enrichment

Simplify correspondence management with ECM integration and AI-driven document processing and content intelligence. Automatically assign cases based on the expertise and priority, while handling disputes, payment reviews, and returned checks. Populate claims and authorization details from core systems to minimize manual effort and enhance accuracy

Duplicate Check, Case Collaborations, and Redirects

Detect duplicate entries to prevent fraud and redundancy. Collaborate across departments, redirect cases seamlessly, and ensure a unified view of investigation and resolution details for complex claims

Detailed Reporting, Visibility, and Analytics

Generate productivity and compliance reports to identify bottlenecks, streamline workflows, and ensure adherence with regulatory needs. Leverage a comprehensive dashboard, offering periodic updates and AI-driven insights from past decisions for consistent outcomes

Automated Case Processing, Correspondence, and Advanced Search

Generate compliant letters automatically for single or bulk cases, eliminating manual intervention and ensuring accuracy. Maintain comprehensive records of decisions, notes, and exceptions. Identify patterns in provider behavior to improve accountability and optimize future processes. Locate any case instantly. Use a quick search to track its lifecycle or an advanced search to filter by specific details

optimized-process

Claims Repair

Streamline claim correction and resubmission for pended, rejected, and drop-out claims. Utilize AI-driven bulk error fixing capabilities and seamless workflow reintegration to turn rejects into paid claims, often within hours

Grievance and Complaints

Automate the end-to-end grievance and complaints process for fast, accurate, and responsive resolutions. Process each complaint individually for classification, tracking, and resolution using best-practice messaging and granular reporting to enable effective root-cause analysis. Leverage GenAI and intelligent classification for advanced document and message processing, ensuring consistent data capture, accurate summaries, and reduced misinterpretation risks for every case

Appeals Solution

clinical reviews, medical record retrieval, and power of attorney outreach. Optimize workflows to ensure expedited appeals handling, robust document processing, and compliance with evolving regulations. Use advanced reporting and decision support drive operational efficiency, accuracy, and positive outcomes for payers, members, and providers

Payment Integrity – Fraud, Waste & Abuse

Verify coding accuracy, medical necessity, and contract compliance before payment. Prevent errors and recover overpayments via systematic audits and review checkpoints. Stop external leakage for invalid payments and employ automated detection of fraud, waste, and abuse using real-time pattern recognition and fraud scoring. Ensure payment accuracy, operational efficiency, and robust protection against improper healthcare payments

Why Choose Newgen’s ClaimsONE Suite?

  • End-to-end automation with GenAI and agentic intelligence
  • Seamless data flow and unified processes
  • Real-time dashboards and deep analytics
  • Scalable, cloud-native deployment
  • Bulletproof HIPAA compliance
claims automation software

Find Your Winning Strategy with Newgen

See Newgen’s low-code digital transformation platform in action. Request a demo of Newgen’s platform and industry-specific applications.

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