Digital. Dynamic. Dependable.
Streamline Service Inquiries for Faster Resolutions and Transformed Experiences
Manage inquiries efficiently by leveraging the solution—built on NewgenONE—an AI/ML-driven, low code platform. Streamline request handling for information, assistance, or clarification from patients, providers, and stakeholders. Enhance transparency and deliver patient-centered care while ensuring every inquiry is resolved in a timely manner. Boost member satisfaction, foster loyalty, and encourage re-enrolment. Address inquiries with care even if they fall outside of compliance, delivering consistent, end-to-end support.
“Implementing Newgen’s Service Inquiry Solution has been transformative for our organization. The solution simplified the management of complex inquiries across channels, ensuring that each case gets resolved quickly and timely. Furthermore, the AI-driven capabilities have not only maximized operational efficiency but also helped build stronger relationships with our members and providers”
– Vice President of Member Services & Appeals, A Leading Health Plan
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
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.
Learn What Newgen’s Service Inquiry Solution Can Do for You
Omnichannel and Comprehensive Inquiry Management
Capture inquiries across all intake channels, including portals, mailrooms, and faxes. Resolve diverse inquiry types by routing them as subcases like appeals, grievances, or complaints. Address case inquiries even if falling outside compliance definitions, covering appeals, grievances, enrollment, pharmacy, claims, authorizations, and general service inquiries for members and providers.
Advanced Document and Data Management
Integrate with Newgen’s ECM for seamless document handling. Classify and route documents using AI-driven classification and extraction. Auto-populate eligibility, claims, and authorization details for enriched case management. Detect and flag duplicate cases, ensuring accurate and efficient resolution processes.
Intelligent Case Handling and Assignment
Assign cases smartly based on expertise and priorities. Manage escalations and optimize resource utilization. Generate compliant correspondence automatically. Get detailed case histories for future reference and accountability. Leverage quick and advanced search features to locate cases efficiently.
Enhanced Workflow Optimization
Prioritize cases intelligently to optimize workflows. Leverage AI to streamline processes, ensure escalations are handled efficiently, and maintain operational excellence. Gain real-time insights into case progress, fostering transparency and resolution accuracy.
360-degree Reporting and Analytics
Generate productivity reports to pinpoint bottlenecks and training needs. Fetch operational reports to optimize workflows. Ensure regulatory compliance with tailored business reports. Leverage dashboards for 360-degree visibility and oversight.
Automated Communication and Oversight
Preview and auto-generate letters to ensure correctness. Keep stakeholders informed with periodic status updates. Enable centralized case monitoring through dashboards. Capture decisions, notes, and exceptions to facilitate seamless management and ensure accountability.
Detailed Case History
Capture all decisions, notes, and exceptions for future reference, ensuring accountability among case workers and facilitating seamless case management.
Smart Case Enrichment
Fetch and auto-populate eligibility, claims, authorization details of members and providers directly from the core system.
Explore Other Solutions for the Payer-Member Journey
Member Portal
Empower members with instant access to information, enhancing convenience and engagement
Enrolment Case Management
Optimize enrolment with an automated, customized system while improving accuracy
Billing Solution
Simplify end-to-end billing process while enhancing precision and overall accuracy
Member Portal
Empower members with instant access to information, enhancing convenience and engagement
Enrolment Case Management
Optimize enrolment with an automated, customized system while improving accuracy
Billing Solution
Simplify end-to-end billing process while enhancing precision and overall accuracy
Explore Other Solutions for the Payer-Member Journey
Member Portal
Empower members with instant access to information, enhancing convenience and engagement
Enrolment Case Management
Optimize enrolment with an automated, customized system while improving accuracy
Billing Solution
Simplify end-to-end billing process while enhancing precision and overall accuracy
Find Your Winning Strategy with Newgen
Request a demo to explore our solutions for Digital Complaints, Appeals, and Grievances.
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