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