Digital. Dynamic. Dependable.
Strengthening Provider Relationships while Resolving Every Claim Dispute Timely
Take every dispute from provider submission and review to resolution. Ensure compliant dispute processing with intelligent orchestration, document management, and governed workflows.
Built for Payers. Designed for Members
Leverage our Complaints, Appeals, & Grievances Suite to build trust with a member-first approach.
Efficient Case Management
Detect and flag duplicates to prevent fraud and speed up medical and pharmacy resolutions. Automate case allocation to optimize bandwidth. Manage escalations, prioritize cases, and extend case timelines as necessary. Ensure robust integration with document management capabilities to streamline content-centric workflows, improve accuracy, and fast-track claims and reviews.
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, including acknowledgment and resolution letters, to ensure adherence to regulatory mandates. Compile case summaries with relevant clinical, medication, formulary, and benefit data and artifacts. Create downloadable case packets for internal/external audits and CMS compliance. Customize reports to meet CMS requirements and gain insightful analytics for informed decision-making.
360-degree Case Visibility, Decision Support, and Integration
Access a comprehensive dashboard to manage cases and get periodic status reports and updates. Leverage AI/ML algorithms to support decision-making and enhance efficiency. Integrate pharmacist and medical director clinical/MD reviews into the process for accurate case assessment. Ensure robust integrations with external portals for smooth data exchange. Ensure data accuracy and compliance through intelligent validation mechanisms.
AI/ML-powered Intelligent Automation for Provider Dispute Processing
Streamline provider dispute handling by leveraging intelligent mailroom. Automate document identification and accurately classify incoming requests. Recognize provider dispute forms and route them to the correct workflow. Eliminate manual effort, reduce errors, and ensure timely, compliant resolution from the very first touchpoint.
Efficient Case Management
Detect and flag duplicates to prevent fraud and speed up medical and pharmacy resolutions. Automate case allocation to optimize bandwidth. Manage escalations, prioritize cases, and extend case timelines as necessary. Ensure robust integration with document management capabilities to streamline content-centric workflows, improve accuracy, and fast-track claims and reviews.
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, including acknowledgment and resolution letters, to ensure adherence to regulatory mandates. Compile case summaries with relevant clinical, medication, formulary, and benefit data and artifacts. Create downloadable case packets for internal/external audits and CMS compliance. Customize reports to meet CMS requirements and gain insightful analytics for informed decision-making.
360-degree Case Visibility, Decision Support, and Integration
Access a comprehensive dashboard to manage cases and get periodic status reports and updates. Leverage AI/ML algorithms to support decision-making and enhance efficiency. Integrate pharmacist and medical director clinical/MD reviews into the process for accurate case assessment. Ensure robust integrations with external portals for smooth data exchange. Ensure data accuracy and compliance through intelligent validation mechanisms.
AI/ML-powered Intelligent Automation for Provider Dispute Processing
Streamline provider dispute handling by leveraging intelligent mailroom. Automate document identification and accurately classify incoming requests. Recognize provider dispute forms and route them to the correct workflow. Eliminate manual effort, reduce errors, and ensure timely, compliant resolution from the very first touchpoint.
Learn What NewgenONE Provider Dispute Resolution Solution 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
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.
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