Digital. Dynamic. Dependable.
Resolving Member and Provider Service Inquiries Faster with Intelligent Orchestration
Streamline member and provider inquiries with routing, knowledge retrieval, and real-time resolution tracking. Deliver responsive service experiences that enhance member satisfaction.
“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 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-backed Service Inquiry Management
Accelerate service inquiry handling by streamlining document identification and accurately classifying incoming requests. Intelligently detect service inquiries and route them to appropriate workflows. Minimize manual effort, improve response time, and ensure every inquiry is promptly addressed.
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-backed Service Inquiry Management
Accelerate service inquiry handling by streamlining document identification and accurately classifying incoming requests. Intelligently detect service inquiries and route them to appropriate workflows. Minimize manual effort, improve response time, and ensure every inquiry is promptly addressed.
Learn What NewgenONE 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
Member Enrollment
A proven one-size-fits-all product enrollment framework, designed to fit the plan’s specific rules.
Billing Solution
Simplify end-to-end billing process while enhancing precision and overall accuracy
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