AI-Powered Provider Dispute Management

Digital. Dynamic. Dependable.

Enhance your payer-provider interactions by optimizing claim disputes and inquiries. Leverage the solution to maximize operational efficiency, ensure compliance, and accelerate resolution time through advanced automation and intelligent features.

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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

Unified Information Capture and Processing

Automated Communications, Audit Documentation, and Packet Generation

360-degree Case Visibility, Decision Support, and Integration

Learn What Newgen’s Provider Dispute Resolution Solution, from Complaints, Appeals & Grievances Suite, Can Do for You

Intelligent Mailroom, Case Assignment, and Enrichment

Simplify correspondence management with ECM integration and AI-driven document processing. 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 meet regulatory needs. Gain complete oversight with 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, eliminating manual intervention and ensuring accuracy. Maintain comprehensive records of decisions, notes, and exceptions. Identify patterns in provider behavior to enhance accountability and future processes. Find cases efficiently with a quick search for lifecycle tracking or advanced search for specific criteria.

Explore Other Solutions for the Payer-Provider Journey

Credentialing

Manage provider credentialing effortlessly with a compliant, automated, and efficient system.

Provider Contract Management

Streamline the contracting process, including amendments, LOAs, single case agreements, and create value-based contracts.

Provider Data Management

Maintain a well-organized directory of providers within the network for superior member experience.

Provider Self-service Portal

Allow providers to submit, update, and view their provider information via a transparent and innovative portal.

Claims Automation

Streamline claims with an AI-driven, low-code automation process.

Provider Relations and Complaints

Enhance provider relationships while streamlining communications and driving a collaborative environment.

SIU & FWA Case Management

Detect and address fraud while enhancing efficiency and ensuring compliance.

Provider Lifecycle Management

Stay current, competitive, and expansion-ready in contracting, credentialing, configuration, provider data management (PDM), and provider self-service.