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Newgen’s Healthcare Payer Practice
Accelerate business performance, control costs,
and meet mandates
Healthcare Payer Landscape
Healthcare industry is booming across       ! Continuous improvement in claim     Content Management (ECM) and,
the globe. However, participants within       disbursement ratio                  Customer Communication
the industry, especially Healthcare         ! Affordable healthcare plans         Management (CCM) would serve as an
Payer organizations, must ensure            ! Smooth transition from ICD 9 to     ideal platform to build solutions for
compliance with a multitude of                ICD 10 code                         automation of key Payer processes.
regulations to avoid potential penalties.   ! Improved Medical Loss Ratio (MLR)
Moreover, to remain competitive in an
industry characterized by dynamic
growth and complex regulations, Payer       To address these challenges, Payer
organizations need focus on meeting         organizations need to adopt an
the following challenges:                   integrated approach to efficiently
                                            manage business processes, maintain   Over 80% of health plans reported
                                            and utilize member/provider
! Better customer service                                                         ICD-10 compliance as the primary
                                            information, foster enhanced
! Compliance to state specific                                                    driver of increased budgets in 2012.
                                            outbound / inbound communication,
  regulation                                and comply with regulations. A
! Cost optimization and increase in         combination of Business Process             IDC Health Insights 2012
  top-line profit                           Management (BPM), Enterprise
Compliance Mandates Drive BPM Adoption For
Healthcare & The Public Sector


                                       Public sector & healthcare:
   “Which of the following have been major drivers for business process management software adoption?”


                        Optimization of processes                                                                 72%

                    Support for compliance efforts                                                       59%

        Increased productivity for process workers                                                    56%
                   The ability to provide real-time
                      visibility into key processes                                               52%
             Ensuring consistent process execution
         across divisional or geographic boundaries                                             49%

           The ability to model business processes                                        41%

   The ability to change processes quickly & easily                                       39%


                                                      Base: 71 software decision-makers
                                                        (multiple responses accepted)

57494                                                                              Source: Forrsights Software Survey, Q4 2010




                         SOLUTIONS FOR BUSINESS PROCESS & CONTENT MANAGEMENT
Newgen’s Healthcare Payer Spectrum
Newgen's solution framework enables          power of Imaging, Document
                                                                                            “Success [of Healthcare Payers] will depend
healthcare organizations to effectively      Management, Business Process
                                                                                            on maintaining focus and assembling the
address the challenges originating from      Management, and Member/Provider                right set of BPM skills. And for the business
regulatory compliance, cost control          Communications Management, to                  process executive acting as the change
and customer satisfaction. Our               render solutions built to address the          agent, this means a laser focus on the
Healthcare Process Automation &              specific requirements of Healthcare            disruptive and transformative aspects of the
Optimization Suite combines the              Payers.                                        process improvement initiative.”
                                                                                                              Forrester Research Inc.




                                                Business Configurable Process
                                           Automation and Improvement Framework




                                                           Preconfigured letter       A quick snapshot of
        Collaborative &             Distributed               templates for          process, performance,        Process standardization,
      integrated creation,           scanning              acknowledgement,             ageing inventory,       auto routing, prioritization of
     capture, organization,      document capture,      additional info, and final     types of appeals &        work items, business rules
     archival and retrieval        image quality        disposition with workflow    grievances, resolved &           SLA adherence
         of documents              enhancement              based validations         escalated/ exception
                                                                                           cases, etc.




                                  Fig: Newgen Solution-Component Framework



                                  Management Dashboards




                   Case Compliance                                                             Ageing Report

                              SOLUTIONS FOR BUSINESS PROCESS & CONTENT MANAGEMENT
Leading US Healthcare Payer transforms multiple
processes with Newgen's Solutions

 Claims Repair
 · Productivity improvement – Organization saved approximately 5K to 7K man-hours
   monthly due to automation
 · Auto generation of Letter to the Provider for any claims communication
 · Integrated platform – auto Member and Provider data pulling from core claims
   application, thus making the process faster



 Appeals & Grievances
 · Increase in user efficiency by 50% due to data integration in single UI for Member/
   Provider/ Claims/ Pharmacy etc.
 · Auto redirect of appeals within department thus reduction in loss of cases
 · Complete audit-trail of case history maintained for Management view




 Enrollment Process
 · Reduced time spent on administrative tasks by sales force by 67%, driving huge
   revenues
 · Reduced TAT on new member enrollment applications by 76% - from 17 to 4 days
 · Reduced error rate in applications by 35% by minimizing manual intervention in the
   enrollment process




 Complaint Tracking
 · Compliance Improvement - Compliance level up by 25%
 · Reduction in complaint resolution time
 · 78% resource optimization




 Provider Contracting
 · 60% reduction in TAT - from 25 to 10 days, to activate a new Provider contract
 · Auto generation of Welcome Letter to the Provider on new contracts
 · Auto alerts for “Contract Renewal”




                          SOLUTIONS FOR BUSINESS PROCESS & CONTENT MANAGEMENT
Claims Repair
Handling claims is often staff intensive      need to minimize provider abrasion      Solution Highlights
and characterized by manual processes.      ! No real-time integrated performance     Ÿ Automated Exceptions Handling -
Moreover, any delay in claims                 management system and on-line             Reduce processing time and mitigate
disbursement leads to high “Penalty           performance metrics for productivity,     risk associated with manual claim
Payout”. This puts payers under               turnaround time and analytics             exceptions handling
constant pressure to improve                ! Need to retrieve data from Core         Ÿ Auto Case Creation - Auto upload
operational performance and reduce            Application in real-time for faster       of information from feed files and case
costs. While claims auto-adjudication         processing                                creation based on work type
has become common place now-a-days,         ! Compliance with state and federal       Ÿ Integrated Platform - Real-time
yet many payers are still processing a
                                              regulations                               information pulling from Core
considerable proportion of claims
                                                                                        System
manually. Claims Repair – addresses
those claims that cannot be handled         Newgen's Claims Repair solution offers    Ÿ Rules-Driven Case Management -
through the auto adjudication process.      rules-driven automation to optimize the     Rule-driven routing of cases based on
These claims are “error out” from one       handling of claim exceptions. Based on      work types; Auto assignment cases
of the multiple systems during              work type and user skills, the solution     based on user skill matrix; Auto
adjudication process.                       prioritizes claim exceptions, and           closure of cases based on updates
                                            automatically routes the right task and     received in feed files
                                            documents to the appropriate staff,       Ÿ Auto Letter Generation -
Challenges
                                            while seamlessly integrating with           Acknowledgement letters, denial
! Time-consuming and erroneous              adjudication systems. Any additional        letters, claims approval, etc.
  processing of claim exceptions due to     information is automatically updated in   Ÿ Compliance Adherence - Real-time
  manual handoffs between                   the case file upon receipt, and             claims lifecycle visibility enabling
  departments                               automatic update-alerts are sent to         management to keep track of each
! Lack of process visibility; Inefficient   claims staff.                               claim and ensure adherence to
  Managed Care Center operations and                                                    service levels and compliance
Appeals & Grievances
Handling appeals and grievances is a          Agreement (SLA) and corresponding        Ÿ Rules Engine: Automatic due date
rigorous, time-consuming, and costly          turnaround time (TAT)                     calculation, validations for doing the
process – more so when it is done           ! Need to adapt to dynamic process          work right the first time, escalations,
manually. Further, the process is highly      changes and regulatory requirements       email-based alerts, and exceptions
regulated, scrutinized and monitored,       ! Inefficient, manual complaint             management
with non-compliance leading to huge           processing with no provision for         Ÿ Content Management: Supporting
fines and penalties. All this adds to the     automated alerts, notifications and       documents such as signature forms,
pressure faced by payer organizations         escalations to managers about the         physician reports, etc. automatically
trying to ensure consistency, quality and     cases with expired due dates              detected upon arrival and attached to
timeliness in responding to member                                                      the corresponding case file; Reduced
requests.                                                                               cases of misplaced and lost documents
                                            Newgen's solution for appeals and
                                            grievances process automation enables      Ÿ Case Prioritization: Based on
Challenges                                  payers to resolve member requests           compliance due date, expedited
! Highly regulated, scrutinized and         within specified timelines, reduce          request and other set of configurable
  monitored process with significant        operational costs, enhance operational      variables
  fines and penalties for non-              efficiency and demonstrate compliance      Ÿ Monitoring Dashboard: End-to-end
  compliance                                – ultimately leading to improved levels     process visibility with real-time
! Need to commit to the consistency,        of member satisfaction and higher profit    reports, allowing management to
  accuracy, and standardization             margins.                                    gauge efficiency
  requirements                                                                         Ÿ Audit History: All changes made to
! Difficult and time-consuming              Solution Highlights                         any data field tracked along with user,
  process of retrieving case                                                            date and, time information
                                            Ÿ Automated and Streamlined
  information from disparate sources          Workflow: Elimination of data entry      Ÿ Auto Routing: Immediate routing
! Providing status to appellants on           errors and process compromises due        and redirection of files between
  their appeals /grievances in real time      to reduced manual handoffs; Process       departments
! Each line of business                       standardization and consistency          Ÿ Auto Letter Generation: Automatic
   (Claims/Pharmacy/Core                      across intake channels, result in         faxes and letters to members and
   Appeals/Grievance) has its own             improved quality and timeliness of        providers; all correspondence record
   different mandated Service Level           decision making                           maintained along with the case file


                              SOLUTIONS FOR BUSINESS PROCESS & CONTENT MANAGEMENT
Member Enrollment
Member enrollment, the first step in the   ! Ineptness to effectively and efficiently     representatives in case of any
Member Servicing cycle, is a critical        handle exceptional cases                     document discrepancies
business process that is often fraught                                                  ŸThe dashboard function offers a quick
with numerous errors and irregularities,   Newgen's end-to-end solution for              snapshot of key performance
due to paper-based, manual processing.     Member Enrollment process                     indicators, with provision for
This leads to the process often            automation enables healthcare payers          generating multiple reports for
becoming frustrating for the prospective   to achieve an efficient, productive, and      different stakeholders, providing end-
member, and time consuming and costly      streamlined enrollment process. The           to-end process visibility to key
for the payer.                             monitoring dashboard helps create a           decision makers
                                           visible, measurable and process              Ÿ Automated generation of HIES
Challenges                                 improvement based ecosystem,                  (Health Insurance Eligibility Screening
! High turnaround time between             allowing management to view the               worksheet), based on income,
  submission and approval of an            complete process from Lead                    number of applicants, family size; Auto
  application                              Generation to Member Enrollment.              color-changing of data-fields of a case
! Significant error rates in application   The solution helps insurers to easily         helps business users to identify
                                           handle the receipt and processing of          important information in an
  processing
                                           enrollment applications and supporting        application
! Inefficient use of staff with a
                                           documentation using an automated             Ÿ Auto letter generation for exceptions
  significant amount of staff time
                                           workflow.                                     (kickbacks) saves valuable time that
  wasted in managing administrative
                                                                                         was earlier wasted in searching
  tasks
                                           Solution Highlights                           missing documents and follow-ups
! Lack of a robust tracking mechanism
                                           Ÿ Automated processing of applications       Ÿ As part of the reengineered flow,
  to monitor each application through
                                             leading to reduced enrollment cycle         every application is tracked through
  the enrollment lifecycle leading to
                                             time from days to hours                     the enrollment lifecycle – client impact
  high loss rates for applications
                                           Ÿ Automated case creation based on            seen through dramatic reduction in
! Difficulty in managing applications
                                            application form (TIFF images)               “lost” applications
  tracking sheet and orphan documents
! Complex business logic for processing    Ÿ Automated reassignment of
  member enrollment business process        applications to marketing
Complaint Tracking & Management
Operating in the highly regulated          ! Absence of a mechanism to track              validation rules with better analysis &
healthcare landscape, it is of utmost        member correspondence                        research capabilities enable speedy
importance to Managed Care                                                                processing and resolution of
organizations to manage complaint          Newgen's complaint tracking and                complaints
tracking appropriately. The challenge is   management solution enables Payers to        Ÿ Extensive reporting capabilities -
to resolve the complaints which have       track each complaint through its               The Business Activity Monitoring tool
come from the Center for Medicare          lifecycle from recording and initiation to     provides end-to-end process visibility,
and Medicaid Services (CMS) in the         investigation, reporting, and closure.         identifying bottlenecks, and allowing
shortest possible time. Moreover,          The solution securely stores all               proactive corrective actions
regulatory infractions may cost            documentation pertaining to the              Ÿ Integration - End-to-end, integrated
healthcare payers huge penalties.          complaints received and simplifies             approach helps populate complainant
                                           search and retrieval of complaint data,        information into and from the core
Challenges                                 to ensure timely resolution of                 system, resulting in improved
! Difficulty in monitoring the status of   complaints and reduce risks associated         operational efficiencies and speedy
  compliance to TAT SLA                    with non-compliance with CMS                   resolution of complaints
! Measurement and monitoring of            standards.                                   Ÿ Audit Trail - Complete audit trail of
  process performance                                                                     actions taken
! Manual search in multiple core           Solution Highlights                          Ÿ Auto Update - Highlighting of
  applications for member                  Ÿ Automated Workflow - Auto                    updates and summary received from
  demographic and eligibility               assignment of received complaints             CMS after each upload, helps speed
  information                               based on skills of the users and              up the process of resolution of cases
! Manual allocation of work                 complaint types                               that are on hold
! Integration of people, workflow and      Ÿ Visibility - Complete visibility in        Ÿ Automatic Alerts - Alerts and
  core system                                terms of SLA monitoring for various          notifications to management based on
! Manual routing of complaints to            issue levels; Auto color changing of         nearing/missed SLAs, TAT
  concerned departments (Pharmacy/           work items helps identify cases            Ÿ Auto Letter Generation -
  Billing/ Claims/ Enrollment) for           nearing deadlines                            Acknowledgement letters, denial
  resolution                               Ÿ Rules Engine - Highly complex                letters, claim approvals etc.




                                SOLUTIONS FOR BUSINESS PROCESS & CONTENT MANAGEMENT
Provider Contract Management
Provider contracting process deals with     ! Missed renewal dates, and data entry      Ÿ Central Repository - All contract
end to end tracking of provider               errors due to manual processing            data and documentation stored
contracts throughout the contract           ! Time consuming activity of Provider        electronically in a central repository,
lifecycle from creation, negotiation,         Contracting document creation and          allowing users to share, collaborate
approval, to termination. Healthcare          approvals                                  and re-use information seamlessly
payers process tens of thousands of         ! Manual process of compliance              Ÿ Auto Routing - Based on the type of
contracts each year. Each provider            auditing                                   transaction, it is routed to the
contract is stored on paper and                                                          respective state level directors; Rule-
managed manually making the process                                                      based routing of contracts for parallel
                                            Newgen's Provider Contract
of updating contracts, variance analysis,                                                processing by different departments
                                            Management solution enables Payers to
and compliance audits time-consuming                                                    Ÿ Document Indexing - Automatic
                                            securely exchange information both
and erroneous.                                                                           indexing of one contract in multiple
                                            within and outside of the organization;
                                            improve operational efficiencies; and        documents and letter generation
Challenges                                  provide user visibility into the contract    based on Lines of Business and
! Paper-based process, with information     data. The solution integrates with           mailroom stacking; Auto document
  stored in disparate databases and         existing critical information systems to     classification and quality control
  isolated filing cabinets                  facilitate enterprise-wide collaboration,   Ÿ Integration - Integration with core
! Time-consuming manual process of          and increases accountability by              application for status tracking and
  searching various sections of the         providing rights-based access at             batch upload of transaction data;
  contract for relevant information         department and user levels.                  Synchronization with credentialing and
                                                                                         claims systems, eliminating
! Document access based on the user's
                                            Solution Highlights                          redundancy and ensuring up-to-date
  and department's rights
                                                                                         and accurate provider data
! No real-time tracking of the contract     Ÿ Contract Management -
                                                                                        Ÿ Integrated Communication - Auto
  status (active/inactive) by Provider        Automated and digitized contract
                                                                                         generation of welcome letters for
  Relationship Representatives (PRRs)         management resulting in faster
                                                                                         every new contract / provider
                                              negotiations & approvals
Our Products


               ™                                                                       ™

Business Process Management Suite                                   Forms Processing Engine
OmniFlow is a platform-independent, scalable Business               OmniExtract is the data capturing solution which extracts
Process Management Suite (BPMS) that enables automation             business-critical information from image documents and
of organizational business processes. OmniFlow is designed          forms. It can extract all possible kinds of information like
to ease the creation, deployment, modification and                  Hand-printed/ Handwritten Characters, Optical Marks,
management of Business Processes. Built using open                  Barcode, Machine-printed Characters and MICR Fonts.
technologies, it has seamless integration abilities allowing it
to be introduced into any IT infrastructure.
                                                                              ™

                ™                                                   Invoice Processing System

Enterprise Content Management Suite
                                                                    Newgen’s Invoice Processing System, with automatic data
                                                                    verification and validation capability, is a solution for
OmniDocs is an Enterprise Content Management (ECM)
                                                                    automatic data capture from semi-structured invoice
Suite for creating, capturing, managing, delivering and
                                                                    documents. It also supports seamless integration with SAP
archiving large volumes of documents and content.
                                                                    and other ERP’s.
OmniDocs manages Scanned Document Images, Electronic
Documents and Emails as records. It also supports
seamless integration with other enterprise applications.
                                                                                     ™
                                                                    Image-Based Check Clearing & Payment
                 ™
                                                                    Newgen’s ChequeFlow is an image based Cheque Processing
Customer Communication Management                                   solution for inward and outward clearing. Advanced and highly
Newgen's Omni Output Management System (O2MS)                       configurable sub-systems for Automatic Signature Verification,
delivers smarter & targeted communications for better               FOREX Cheque Processing, PDC Management, ECS/ACH
customer experiences. It offers the capability of leveraging        mandates, add-ons for Cheque Deposit Machine/ Kiosks.
prime paper space for customer centric inline advertisement,
consolidation across multiple products. It enables secure
communication on improved templates with rich designs and                                    ™
graphical representation of analytics across multiple
                                                                    Governance, Risk & Compliance
distribution channels. In addition easy archival & retrieval of
correspondences for presentment & efficient customer                Compliance Manager is an integrated solution for
request resolution is achieved using this enterprise application.   Governance, Risk and Compliance that’s geared to ensure
                                                                    compliance with standards, best practices and guidelines of
                                                                    various regulatory acts.
                     ™
Enterprise Reports Management and Archival
OmniReports stores trillions of computer-generated output                          ™
pages and reports in a highly compressed form. It has a high-       Production and Distributed Scanning Suite
speed ingestion process with simple interactive definitions,        OmniScan is a production and distribution software scanning
enables instant access to terabytes of reports independent of       for document image capture. It supports distributed
business application, and is fully searchable at field/row/page     scanning, image quality enhancement and delivery of
levels. OmniReports is ideal for sun-setting of business            documents to business systems.
applications as well as optimizing core system performance by
purging historical reports.




                            SOLUTIONS FOR BUSINESS PROCESS & CONTENT MANAGEMENT
About Newgen
• Leading Global Provider of Business Process Management (BPM), Enterprise Content
  Management (ECM) & Customer Communication Management (CCM)
• 850+ installations across 45 countries
• Solutions for Banking, Insurance, Healthcare, BPO/SSCs, Telecom and Government
• Credited with some of the world's largest implementations
• Innovative culture, consistent R&D investments, 35 patents
• Employee strength 1100+
• Certified for ISO 9001:2008, ISO 27001:2005 and CMMI Level3




                              What Analysts Say                                      Investors

           Proven for              Flexible and       Value for Money
         Large volumes            Cost Effective


                         ®




         2010 BPMS &              2011, DOCCM           2011 BPM
         2011 ECM MQ              Wave Report         Decision Matrix
            Reports




                             SOLUTIONS FOR BUSINESS PROCESS & CONTENT MANAGEMENT

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Newgen’s Healthcare Payer Practice

  • 1. Newgen’s Healthcare Payer Practice Accelerate business performance, control costs, and meet mandates
  • 2. Healthcare Payer Landscape Healthcare industry is booming across ! Continuous improvement in claim Content Management (ECM) and, the globe. However, participants within disbursement ratio Customer Communication the industry, especially Healthcare ! Affordable healthcare plans Management (CCM) would serve as an Payer organizations, must ensure ! Smooth transition from ICD 9 to ideal platform to build solutions for compliance with a multitude of ICD 10 code automation of key Payer processes. regulations to avoid potential penalties. ! Improved Medical Loss Ratio (MLR) Moreover, to remain competitive in an industry characterized by dynamic growth and complex regulations, Payer To address these challenges, Payer organizations need focus on meeting organizations need to adopt an the following challenges: integrated approach to efficiently manage business processes, maintain Over 80% of health plans reported and utilize member/provider ! Better customer service ICD-10 compliance as the primary information, foster enhanced ! Compliance to state specific driver of increased budgets in 2012. outbound / inbound communication, regulation and comply with regulations. A ! Cost optimization and increase in combination of Business Process IDC Health Insights 2012 top-line profit Management (BPM), Enterprise
  • 3. Compliance Mandates Drive BPM Adoption For Healthcare & The Public Sector Public sector & healthcare: “Which of the following have been major drivers for business process management software adoption?” Optimization of processes 72% Support for compliance efforts 59% Increased productivity for process workers 56% The ability to provide real-time visibility into key processes 52% Ensuring consistent process execution across divisional or geographic boundaries 49% The ability to model business processes 41% The ability to change processes quickly & easily 39% Base: 71 software decision-makers (multiple responses accepted) 57494 Source: Forrsights Software Survey, Q4 2010 SOLUTIONS FOR BUSINESS PROCESS & CONTENT MANAGEMENT
  • 4. Newgen’s Healthcare Payer Spectrum Newgen's solution framework enables power of Imaging, Document “Success [of Healthcare Payers] will depend healthcare organizations to effectively Management, Business Process on maintaining focus and assembling the address the challenges originating from Management, and Member/Provider right set of BPM skills. And for the business regulatory compliance, cost control Communications Management, to process executive acting as the change and customer satisfaction. Our render solutions built to address the agent, this means a laser focus on the Healthcare Process Automation & specific requirements of Healthcare disruptive and transformative aspects of the Optimization Suite combines the Payers. process improvement initiative.” Forrester Research Inc. Business Configurable Process Automation and Improvement Framework Preconfigured letter A quick snapshot of Collaborative & Distributed templates for process, performance, Process standardization, integrated creation, scanning acknowledgement, ageing inventory, auto routing, prioritization of capture, organization, document capture, additional info, and final types of appeals & work items, business rules archival and retrieval image quality disposition with workflow grievances, resolved & SLA adherence of documents enhancement based validations escalated/ exception cases, etc. Fig: Newgen Solution-Component Framework Management Dashboards Case Compliance Ageing Report SOLUTIONS FOR BUSINESS PROCESS & CONTENT MANAGEMENT
  • 5. Leading US Healthcare Payer transforms multiple processes with Newgen's Solutions Claims Repair · Productivity improvement – Organization saved approximately 5K to 7K man-hours monthly due to automation · Auto generation of Letter to the Provider for any claims communication · Integrated platform – auto Member and Provider data pulling from core claims application, thus making the process faster Appeals & Grievances · Increase in user efficiency by 50% due to data integration in single UI for Member/ Provider/ Claims/ Pharmacy etc. · Auto redirect of appeals within department thus reduction in loss of cases · Complete audit-trail of case history maintained for Management view Enrollment Process · Reduced time spent on administrative tasks by sales force by 67%, driving huge revenues · Reduced TAT on new member enrollment applications by 76% - from 17 to 4 days · Reduced error rate in applications by 35% by minimizing manual intervention in the enrollment process Complaint Tracking · Compliance Improvement - Compliance level up by 25% · Reduction in complaint resolution time · 78% resource optimization Provider Contracting · 60% reduction in TAT - from 25 to 10 days, to activate a new Provider contract · Auto generation of Welcome Letter to the Provider on new contracts · Auto alerts for “Contract Renewal” SOLUTIONS FOR BUSINESS PROCESS & CONTENT MANAGEMENT
  • 6. Claims Repair Handling claims is often staff intensive need to minimize provider abrasion Solution Highlights and characterized by manual processes. ! No real-time integrated performance Ÿ Automated Exceptions Handling - Moreover, any delay in claims management system and on-line Reduce processing time and mitigate disbursement leads to high “Penalty performance metrics for productivity, risk associated with manual claim Payout”. This puts payers under turnaround time and analytics exceptions handling constant pressure to improve ! Need to retrieve data from Core Ÿ Auto Case Creation - Auto upload operational performance and reduce Application in real-time for faster of information from feed files and case costs. While claims auto-adjudication processing creation based on work type has become common place now-a-days, ! Compliance with state and federal Ÿ Integrated Platform - Real-time yet many payers are still processing a regulations information pulling from Core considerable proportion of claims System manually. Claims Repair – addresses those claims that cannot be handled Newgen's Claims Repair solution offers Ÿ Rules-Driven Case Management - through the auto adjudication process. rules-driven automation to optimize the Rule-driven routing of cases based on These claims are “error out” from one handling of claim exceptions. Based on work types; Auto assignment cases of the multiple systems during work type and user skills, the solution based on user skill matrix; Auto adjudication process. prioritizes claim exceptions, and closure of cases based on updates automatically routes the right task and received in feed files documents to the appropriate staff, Ÿ Auto Letter Generation - Challenges while seamlessly integrating with Acknowledgement letters, denial ! Time-consuming and erroneous adjudication systems. Any additional letters, claims approval, etc. processing of claim exceptions due to information is automatically updated in Ÿ Compliance Adherence - Real-time manual handoffs between the case file upon receipt, and claims lifecycle visibility enabling departments automatic update-alerts are sent to management to keep track of each ! Lack of process visibility; Inefficient claims staff. claim and ensure adherence to Managed Care Center operations and service levels and compliance
  • 7. Appeals & Grievances Handling appeals and grievances is a Agreement (SLA) and corresponding Ÿ Rules Engine: Automatic due date rigorous, time-consuming, and costly turnaround time (TAT) calculation, validations for doing the process – more so when it is done ! Need to adapt to dynamic process work right the first time, escalations, manually. Further, the process is highly changes and regulatory requirements email-based alerts, and exceptions regulated, scrutinized and monitored, ! Inefficient, manual complaint management with non-compliance leading to huge processing with no provision for Ÿ Content Management: Supporting fines and penalties. All this adds to the automated alerts, notifications and documents such as signature forms, pressure faced by payer organizations escalations to managers about the physician reports, etc. automatically trying to ensure consistency, quality and cases with expired due dates detected upon arrival and attached to timeliness in responding to member the corresponding case file; Reduced requests. cases of misplaced and lost documents Newgen's solution for appeals and grievances process automation enables Ÿ Case Prioritization: Based on Challenges payers to resolve member requests compliance due date, expedited ! Highly regulated, scrutinized and within specified timelines, reduce request and other set of configurable monitored process with significant operational costs, enhance operational variables fines and penalties for non- efficiency and demonstrate compliance Ÿ Monitoring Dashboard: End-to-end compliance – ultimately leading to improved levels process visibility with real-time ! Need to commit to the consistency, of member satisfaction and higher profit reports, allowing management to accuracy, and standardization margins. gauge efficiency requirements Ÿ Audit History: All changes made to ! Difficult and time-consuming Solution Highlights any data field tracked along with user, process of retrieving case date and, time information Ÿ Automated and Streamlined information from disparate sources Workflow: Elimination of data entry Ÿ Auto Routing: Immediate routing ! Providing status to appellants on errors and process compromises due and redirection of files between their appeals /grievances in real time to reduced manual handoffs; Process departments ! Each line of business standardization and consistency Ÿ Auto Letter Generation: Automatic (Claims/Pharmacy/Core across intake channels, result in faxes and letters to members and Appeals/Grievance) has its own improved quality and timeliness of providers; all correspondence record different mandated Service Level decision making maintained along with the case file SOLUTIONS FOR BUSINESS PROCESS & CONTENT MANAGEMENT
  • 8. Member Enrollment Member enrollment, the first step in the ! Ineptness to effectively and efficiently representatives in case of any Member Servicing cycle, is a critical handle exceptional cases document discrepancies business process that is often fraught ŸThe dashboard function offers a quick with numerous errors and irregularities, Newgen's end-to-end solution for snapshot of key performance due to paper-based, manual processing. Member Enrollment process indicators, with provision for This leads to the process often automation enables healthcare payers generating multiple reports for becoming frustrating for the prospective to achieve an efficient, productive, and different stakeholders, providing end- member, and time consuming and costly streamlined enrollment process. The to-end process visibility to key for the payer. monitoring dashboard helps create a decision makers visible, measurable and process Ÿ Automated generation of HIES Challenges improvement based ecosystem, (Health Insurance Eligibility Screening ! High turnaround time between allowing management to view the worksheet), based on income, submission and approval of an complete process from Lead number of applicants, family size; Auto application Generation to Member Enrollment. color-changing of data-fields of a case ! Significant error rates in application The solution helps insurers to easily helps business users to identify handle the receipt and processing of important information in an processing enrollment applications and supporting application ! Inefficient use of staff with a documentation using an automated Ÿ Auto letter generation for exceptions significant amount of staff time workflow. (kickbacks) saves valuable time that wasted in managing administrative was earlier wasted in searching tasks Solution Highlights missing documents and follow-ups ! Lack of a robust tracking mechanism Ÿ Automated processing of applications Ÿ As part of the reengineered flow, to monitor each application through leading to reduced enrollment cycle every application is tracked through the enrollment lifecycle leading to time from days to hours the enrollment lifecycle – client impact high loss rates for applications Ÿ Automated case creation based on seen through dramatic reduction in ! Difficulty in managing applications application form (TIFF images) “lost” applications tracking sheet and orphan documents ! Complex business logic for processing Ÿ Automated reassignment of member enrollment business process applications to marketing
  • 9. Complaint Tracking & Management Operating in the highly regulated ! Absence of a mechanism to track validation rules with better analysis & healthcare landscape, it is of utmost member correspondence research capabilities enable speedy importance to Managed Care processing and resolution of organizations to manage complaint Newgen's complaint tracking and complaints tracking appropriately. The challenge is management solution enables Payers to Ÿ Extensive reporting capabilities - to resolve the complaints which have track each complaint through its The Business Activity Monitoring tool come from the Center for Medicare lifecycle from recording and initiation to provides end-to-end process visibility, and Medicaid Services (CMS) in the investigation, reporting, and closure. identifying bottlenecks, and allowing shortest possible time. Moreover, The solution securely stores all proactive corrective actions regulatory infractions may cost documentation pertaining to the Ÿ Integration - End-to-end, integrated healthcare payers huge penalties. complaints received and simplifies approach helps populate complainant search and retrieval of complaint data, information into and from the core Challenges to ensure timely resolution of system, resulting in improved ! Difficulty in monitoring the status of complaints and reduce risks associated operational efficiencies and speedy compliance to TAT SLA with non-compliance with CMS resolution of complaints ! Measurement and monitoring of standards. Ÿ Audit Trail - Complete audit trail of process performance actions taken ! Manual search in multiple core Solution Highlights Ÿ Auto Update - Highlighting of applications for member Ÿ Automated Workflow - Auto updates and summary received from demographic and eligibility assignment of received complaints CMS after each upload, helps speed information based on skills of the users and up the process of resolution of cases ! Manual allocation of work complaint types that are on hold ! Integration of people, workflow and Ÿ Visibility - Complete visibility in Ÿ Automatic Alerts - Alerts and core system terms of SLA monitoring for various notifications to management based on ! Manual routing of complaints to issue levels; Auto color changing of nearing/missed SLAs, TAT concerned departments (Pharmacy/ work items helps identify cases Ÿ Auto Letter Generation - Billing/ Claims/ Enrollment) for nearing deadlines Acknowledgement letters, denial resolution Ÿ Rules Engine - Highly complex letters, claim approvals etc. SOLUTIONS FOR BUSINESS PROCESS & CONTENT MANAGEMENT
  • 10. Provider Contract Management Provider contracting process deals with ! Missed renewal dates, and data entry Ÿ Central Repository - All contract end to end tracking of provider errors due to manual processing data and documentation stored contracts throughout the contract ! Time consuming activity of Provider electronically in a central repository, lifecycle from creation, negotiation, Contracting document creation and allowing users to share, collaborate approval, to termination. Healthcare approvals and re-use information seamlessly payers process tens of thousands of ! Manual process of compliance Ÿ Auto Routing - Based on the type of contracts each year. Each provider auditing transaction, it is routed to the contract is stored on paper and respective state level directors; Rule- managed manually making the process based routing of contracts for parallel Newgen's Provider Contract of updating contracts, variance analysis, processing by different departments Management solution enables Payers to and compliance audits time-consuming Ÿ Document Indexing - Automatic securely exchange information both and erroneous. indexing of one contract in multiple within and outside of the organization; improve operational efficiencies; and documents and letter generation Challenges provide user visibility into the contract based on Lines of Business and ! Paper-based process, with information data. The solution integrates with mailroom stacking; Auto document stored in disparate databases and existing critical information systems to classification and quality control isolated filing cabinets facilitate enterprise-wide collaboration, Ÿ Integration - Integration with core ! Time-consuming manual process of and increases accountability by application for status tracking and searching various sections of the providing rights-based access at batch upload of transaction data; contract for relevant information department and user levels. Synchronization with credentialing and claims systems, eliminating ! Document access based on the user's Solution Highlights redundancy and ensuring up-to-date and department's rights and accurate provider data ! No real-time tracking of the contract Ÿ Contract Management - Ÿ Integrated Communication - Auto status (active/inactive) by Provider Automated and digitized contract generation of welcome letters for Relationship Representatives (PRRs) management resulting in faster every new contract / provider negotiations & approvals
  • 11. Our Products ™ ™ Business Process Management Suite Forms Processing Engine OmniFlow is a platform-independent, scalable Business OmniExtract is the data capturing solution which extracts Process Management Suite (BPMS) that enables automation business-critical information from image documents and of organizational business processes. OmniFlow is designed forms. It can extract all possible kinds of information like to ease the creation, deployment, modification and Hand-printed/ Handwritten Characters, Optical Marks, management of Business Processes. Built using open Barcode, Machine-printed Characters and MICR Fonts. technologies, it has seamless integration abilities allowing it to be introduced into any IT infrastructure. ™ ™ Invoice Processing System Enterprise Content Management Suite Newgen’s Invoice Processing System, with automatic data verification and validation capability, is a solution for OmniDocs is an Enterprise Content Management (ECM) automatic data capture from semi-structured invoice Suite for creating, capturing, managing, delivering and documents. It also supports seamless integration with SAP archiving large volumes of documents and content. and other ERP’s. OmniDocs manages Scanned Document Images, Electronic Documents and Emails as records. It also supports seamless integration with other enterprise applications. ™ Image-Based Check Clearing & Payment ™ Newgen’s ChequeFlow is an image based Cheque Processing Customer Communication Management solution for inward and outward clearing. Advanced and highly Newgen's Omni Output Management System (O2MS) configurable sub-systems for Automatic Signature Verification, delivers smarter & targeted communications for better FOREX Cheque Processing, PDC Management, ECS/ACH customer experiences. It offers the capability of leveraging mandates, add-ons for Cheque Deposit Machine/ Kiosks. prime paper space for customer centric inline advertisement, consolidation across multiple products. It enables secure communication on improved templates with rich designs and ™ graphical representation of analytics across multiple Governance, Risk & Compliance distribution channels. In addition easy archival & retrieval of correspondences for presentment & efficient customer Compliance Manager is an integrated solution for request resolution is achieved using this enterprise application. Governance, Risk and Compliance that’s geared to ensure compliance with standards, best practices and guidelines of various regulatory acts. ™ Enterprise Reports Management and Archival OmniReports stores trillions of computer-generated output ™ pages and reports in a highly compressed form. It has a high- Production and Distributed Scanning Suite speed ingestion process with simple interactive definitions, OmniScan is a production and distribution software scanning enables instant access to terabytes of reports independent of for document image capture. It supports distributed business application, and is fully searchable at field/row/page scanning, image quality enhancement and delivery of levels. OmniReports is ideal for sun-setting of business documents to business systems. applications as well as optimizing core system performance by purging historical reports. SOLUTIONS FOR BUSINESS PROCESS & CONTENT MANAGEMENT
  • 12. About Newgen • Leading Global Provider of Business Process Management (BPM), Enterprise Content Management (ECM) & Customer Communication Management (CCM) • 850+ installations across 45 countries • Solutions for Banking, Insurance, Healthcare, BPO/SSCs, Telecom and Government • Credited with some of the world's largest implementations • Innovative culture, consistent R&D investments, 35 patents • Employee strength 1100+ • Certified for ISO 9001:2008, ISO 27001:2005 and CMMI Level3 What Analysts Say Investors Proven for Flexible and Value for Money Large volumes Cost Effective ® 2010 BPMS & 2011, DOCCM 2011 BPM 2011 ECM MQ Wave Report Decision Matrix Reports SOLUTIONS FOR BUSINESS PROCESS & CONTENT MANAGEMENT