Claims Repair

For Healthcare

Medicare Enrollment:

The process involves receiving enrollment applications and member requests through various channels like Regular Mail, E-mail, and Fax etc. These requests can have various permutations and combinations of plan changes, address changes, disenrollments etc. These have to be processed through specified time frames ( a defined Turn Around Time)  as mandated by regulatory bodies. The objective is to reduce the Turn-Around-Time of processing an application, reduce the number of error rates while processing and reduce the number of applications getting lost while processing.

1. The key factors that determine and maintain Managed Care's success are Speed, accuracy, and the ability to monitor and report on performance. Each application and member request needs to be tracked from start to finish, in an integrated workflow, with the ability to monitor and report on both system and associate performance.
2. The solution needs to have applications coming from multiple intake channels, guiding them through an efficient workflow, tying them into the core application system and retrieving archived documents as deemed necessary.
3. Ensure high quality consistently through discipline, control and compliance.
4. The solution requires a developed reporting platform to deliver on time and real time reports by way of dashboards

Newgen has developed a comprehensive BPM (OmniFlow) based workflow solution to automate the entire Medicare enrollment process. It starts from managing the incoming applications from multiple intake channels, having multiple result types, processing through multiple departments and providing comprehensive ‘Quality Checks’ that enable both improvement/reduction in errors of processing as well as improving the productivity of employees. Incoming applications and requests are imaged, classified, and processed according to business processes.

The single unified Newgen work desk provided a consolidated view of all incoming applications in electronic format along with the electronic form. Using Newgen’s integration platform users are able to perform Data Entry/Validation/Quality Checks, get info from other core systems for processing/productivity enhancements without having to logging into these applications.

Finally, the Business Activity Monitoring tool from Newgen helps create a visible, measurable and process improvement based ecosystem.  It also provides batch reports offering in-depth view of applications processed during the day, month, quarter, year. The tool allows for generating multiple reports that capture key performance indicators of different stakeholders. Weekly report offers clients interim progress update across multiple stakeholders and Business Lines.

Newgen has also developed multiple solutions around Medicare Enrollment like the Late Eligibility Penalty, LEP Reconsideration (Maximus Reconsideration), Best Available Evidence.