NewgenONE Platform for
Claims Processing for Health Insurance
Expedite claim settlement by automating the end-to-end health claims journey
Automating health insurance claims journey can help process large volumes of transactions while improving claims settlement accuracy and minimizing medical claims errors. Newgen’s health claims automation solution offers comprehensive features to enhance the quality of services to policyholders while improving the overall health claims management process, making it faster, more accurate, and efficient.
Features of Claims Processing Solution
Omnichannel Claim Initiation
Efficiently capture claim details and policyholder information from multiple sources, including emails, portals, branches, and social networks. Fetch and categorize documents updated during claim initiation by the backend system for easy reference. Leverage inbuilt OCR extraction capabilities to retrieve relevant data from standard documents uploaded during the claims process. Effectively manage and streamline various pre-authorization requests, including new pre-authorization, pre-authorization extension, additional information requests, and pre-authorization cancellations.
Rule-based Claims Adjudication
Automate case routing to adjudicators based on multiple set criteria such as claim amount, claim type, approval authority, and case level complexity. Execute payable summary calculation with smart rule-based system. Automatically classify claims as ‘fast track’ or ‘non-fast track’ with predefined business rules. Enable case referral to various departments such as CSO, fraud, and investigation, underwriting, and provider enrolment without interrupting case processing.
Seamless Integration
Seamlessly integrate with policy admin system (PAS) to fetch all policy and coverage-related details in a single screen. In addition, integration with third-party systems can capture details and perform checks and validations.
Centralized Document Management
Benefit from a central document repository that allows easy access to stored documents. Quickly retrieve provider-related documents like rate lists, agreements, etc, while processing cashless claims.
Real-time Document Generation
Achieve real-time document generation, including claim acknowledgment letters, approval letters, and settlement letters. Auto-generate file payments for providers and enable claim payouts, including generation of pay advice and accounting entries
Monitoring and Insights
Establish defined KPIs to track and assess user efficiency. Bring transparency and timely resolutions to claims processing with escalation matrix and monitoring reports. Users can get real-time status updates of claim registration, tracking, and management of submitted and generate comprehensive claim reports linked to customer utilization, network availability, and costs.
Brands using Newgen Platform
