Digital. Dynamic. Dependable.
Maximizing Revenue and Transforming Member Experience through an Intelligently Orchestrated Claims Management Suite
Process the healthcare claims lifecycle from submission and adjudication to payment. Reduce processing time, enhance accuracy, and minimize leakage with smart triaging, automated compliance checks, and governed workflows on the NewgenONE ClaimsONE.
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
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
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
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
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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