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Case Study


FORTUNE 500 HEALTHCARE PAYER AUTOMATES APPEALS & GRIEVANCES PROCESS WITH NEWGEN

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Home » Resources » Case Study: Fortune 500 Healthcare Payer Automates Appeals &
Grievances Process with Newgen



OVERVIEW

The customer is a multi-state healthcare payer and offers both Medicare and
Medicaid plans

DAY-TO-DAY CHALLENGES

New regulations and manual processes for managing Appeals and Grievances were
posing a huge challenge to the organization. The absence of a centralized
repository, lack of systems for auto-generation of various letters, inability to
validate duplicate cases and long turnaround times were symptoms of a Health
Plan process gone wrong. The Health Plan realized that there was an urgent need
to streamline and automate their Appeals and Grievances management process.

Newgen was chosen for the job because of our expertise in Intelligent Business
Process Management (BPM), Enterprise Content Management (ECM) and Customer
Communication Management (CCM) based Healthcare solutions.

TIMELY AND EFFECTIVE RESOLUTION OF APPEALS AND GRIEVANCES

Newgen deployed its appeals and grievances management solution based on its
Intelligent Business Process Management platform integrated with its Enterprise
Content Management system.

The solution enabled the Health Plan to resolve member requests within specified
timelines, reduce operational inefficiencies and demonstrate compliance, leading
to improved member satisfaction.

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Learn More

Case Study

APPEALS & GRIEVANCES AUTOMATION FOR A LEADING HEALTH PLAN

The Health Plan expedited its resolution process and maximized overall
efficiencies by a significant margin. ...

eBook

FIVE REASONS YOUR APPEALS AND GRIEVANCES PROCESS HURTS

There’s an enormous cost incurred behind every appeal filed whether upheld or
not. According to ...

Video

APPEALS & GRIEVANCES MANAGEMENT SOLUTION BY NEWGEN SOFTWARE

Healthcare payers have realized the importance of creating faster and more
efficient Complaints, Appeals and ...

Whitepaper

OPTIMIZE YOUR COMPLAINTS, APPEALS AND GRIEVANCES PROCESS

Health Plans need to be agile to the dynamic business and regulatory
environment. They must ...



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