Claims Repair

Optimize claims processing and cut down operational costs

Request Information

  • Ensure Responsiveness and Compliance

    Enable faster and accurate claim settlements through reduced turn around times, leading to high degree of customer satisfaction and adherence to regulatory mandates.

  • Create Integrated Operational Framework

    Consolidate critical information across multiple enterprise applications through a single unified claims repair system, bringing various processes under a single purview.

  • Facilitate First-Time Right Adjudication

    Reduce error rates through increased levels of automation and operational robustness, with skill based assignment of claims to adjudicators.

Flyer: Automating the Claims Repair process with Newgen

Download Case Study

The emergence of new consumer driven health plans and elaborate risk-sharing agreements between payers and providers have led to highly complex and labor intensive claims management process. Auto adjudication has to a great extent simplified the process for payers and enabled faster resolutions. However, for cases that fall beyond the gambit of business rules, there still remains scope for errors. With healthcare payers losing an average of $3.2 billion every year from inefficient manual processes, payers need an advanced Claims Repair solution to expedite claims settlement for cases that are “error out” from the system.

Newgen Claims Repair Solution

Healthcare Claims Repair Solution

Newgen’s Claims Repair solution brings intelligence driven flexibility into the rule based auto adjudication framework to create an agile platform that optimizes complex claims processing, drives down costs and responds rapidly to new benefits designs, provider contracting models and the latest regulatory mandates. It combines business configurable process automation with claims processing best-practice templates across the adjudication process.

Key Features of Newgen Claims Repair Solution

  • Consolidated & automatic intake of claims
  • Auto segregation and assignment of claims to processors based on their skill sets
  • Auto generation of correspondence to the Provider for any denied claims
  • Auto Upload of information from feed files and case creation based on work types
  • Real time information extraction from ‘Core System’ reducing the time spent on tracking providers, members and claims
  • Unified desktop to search and view real time Member, Provider, Authorization & Claims data, archived in one or multiple HMS. Ability to view the paper claim image
  • Ability to flow claims between onshore and offshore teams
  • Ability to flow claims between multiple internal onshore departments
  • Ability to configure approval hierarchy for high value claims
  • Configuration of multiple reports ensures complete visibility on the status of each claim throughout the “Claims Lifecycle

Benefits of Newgen’s Claims Repair software


Efficient Information Management

Healthcare Efficient Information Management

  • Streamlines information flow across multiple applications and users to result in fast track processing while increasing the first time right percentage
  • Seamless integration with core system brings uniformity and efficiency within operational framework

Better Customer Communications

Healthcare Customer Communication Management

  • Facilitates automated and intelligent customer communications at key stages of Claims Lifecycle
  • Renders consistency and user friendliness to all communications resulting in enhanced customer experience and brand loyalty

Adherence to Compliance & Fraud Detection

Healthcare Compliance Fraud Solution

  • Lowers rate of errors through operational robustness and higher levels of automation
  • Maintains comprehensive case history to allow internal and external case audit

Increased Business Agility & Responsiveness

Healthcare Business Process Management

  • Provides management with visibility and control over volume of claims getting rejected from the adjudication system
  • Enables immediate, actionable decisions for mission critical processes, improving efficiency and shortening cycle time

Operational Efficiency

Healthcare Operation Efficiency of Claims Repair Software

  • Proactively identifies “Possible Errors” for cases based on past history enabling processing of claims in a single attempt
  • Leads to reduction in manual handoffs and thus reduced instances of errors/rework
  • Consolidates all channels used to receive rejections into a single unified channel with a high-performance, single-pass process to validate, acknowledge and route data

Request A Demo of Claims Repair Software

The US Healthcare market is undergoing rapid changes, With healthcare payers losing an average of $3.2 billion every year from inefficient manual processes, current claim processing approaches are clearly unsustainable for long-term growth and profitability.

Newgen’s Claims Repair solution brings intelligence and flexibility into the rule based auto adjudication framework to create an agile platform that optimizes complex claims processing, drives down costs, responds rapidly to new benefit plans, provider contracting models and the latest regulatory mandates. It combines business configurable process automation with claims processing best-practice templates across the adjudication process. Some of the key benefits are:

  • Auto Case Creation, Automated Claims Exception Processing & Auto Letter Generation.
  • Compliance Adherence, Productivity Improvement & Resource Optimization
  • Proactive Error Identification & Streamline Operational Efficiency.