Digital. Dynamic. Dependable.
Simplify Complaints, Appeals, and Grievances for Accelerated Resolutions
Streamline every touchpoint, from intake to resolution, with rule-driven workflows and intelligent case management while meeting federal and state guidelines. Designed for Medicaid, Medicare, ACA/Exchange, and commercial health plans, leverage the integrated Complaints, Appeals, and Grievances Suite, built on NewgenONE—an AI-enabled unified digital transformation platform, to enhance engagement through mailroom automation, personalized correspondences, and digital responses. Employ AI-driven decision-making, real-time insights, and document management to maximize efficiency. Auto-summarize documents, resolve claim denials faster, and enhance member services with Generative AI.
“Working with Newgen has been transformational for us. Their Complaints, Appeals, and Grievance solution have boosted our efficiency by 215% and improved our STAR rating by 1.5 points. Newgen’s team was with us in every step of the way, helping us achieve a 3:1 ROI.”
– Vice President of Member Services & Appeals, A Leading Health Plan
Complaints, Appeals & Grievances Solution: Buy All-in-one Pack or Choose an Individual Solution
Member and Provider Service Inquiries
Ensure smooth processing of inquiries while enhancing member and provider experience
Member and Provider Service Inquiries
Ensure smooth processing of inquiries while enhancing member and provider experience
Learn What Newgen’s Digital Complaints, Appeals, and Grievances Solution Can Do for You
Efficient Case Management
Detect and flag duplicates to prevent fraud and speed up 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 efficient case processing. Fetch eligibility details of members and providers from the core system in one place. Leverage GenAI to extract critical data, classify records, and generate instant summaries from documents (medical records and EOBs) 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 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 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.
Efficient Case Management
Detect and flag duplicates to prevent fraud and speed up 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 efficient case processing. Fetch eligibility details of members and providers from the core system in one place. Leverage GenAI to extract critical data, classify records, and generate instant summaries from documents (medical records and EOBs) 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 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 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.
Explore Other Solutions for the Payer-Member Journey
Member Portal
Empower members with instant access to information, enhancing convenience and engagement
Enrollment Case Management
Optimize enrollment with an automated, customized system while improving accuracy
Premium Billing
Simplify end-to-end billing process while enhancing precision and overall accuracy
Sales and Retention
Boost sales and retention with an AI-driven, automated system while gaining real-time insights into the process
Medicare Mobile Enrollment App
Member Service Inquiries
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.
Find Your Winning Strategy with Newgen
Schedule a Demo to See Newgen’s Digital Complaints, Appeals, and Grievances Solution in Action
Request a Demo