Case Study: Leading Health Plan Company achieves 98% CMS compliance and 90% error reduction with Newgen Software

Automation of Appeals & Grievances process for a leading health plan

The Health Plan, a managed care organization serving about 25,000 members, faced a document‑heavy appeals and grievances process coming in from email, paper, web, walk‑ins and fax. Multiple systems, manual data entry, inconsistent processes, poor cross‑department collaboration and limited tracking created long turn‑around times and increased the risk of non‑compliance and low member satisfaction.

Partnering with Newgen, the plan implemented a dynamic intake engine plus OmniFlow iBPS, OmniDocs and a Business Activity Monitor to automate intake, workflows, content management, alerts and reporting while enabling real‑time visibility and collaboration. The result was faster, more accurate case handling (overall case lifecycle time cut roughly in half; initiation −50%, preparation and determination −40%), a 98% improvement in CMS compliance, error rates down over 90%, and major gains in report delivery, due‑date adherence, external collaboration and data validation.