Healthcare providers face ongoing challenges in managing Utilization Management (UM), Clinical Documentation Integrity (CDI), and Denials Management. These functions are critical to ensuring both high-quality patient care and optimized revenue performance. Traditionally, providers have turned to specialized vendors for support. However, with the advent of AI-powered, low-code enterprise platforms like NewgenONE, there is a smarter, more integrated way forward.
NewgenONE empowers CDI teams with advanced ECM capabilities that automatically capture, index, and analyze clinical documents. AI-assisted tools flag documentation gaps, suggest physician queries, and enable real-time feedback loops—ensuring that records are complete and DRG-aligned. This reduces reliance on retrospective fixes and supports accurate, compliant coding from the start.
NewgenONE’s BPM engine orchestrates end-to-end UM workflows, enabling real-time reviews and decisions. Predictive analytics highlight high-risk cases, while seamless integrations with EHRs and payer systems simplify preauthorization, concurrent review, and discharge planning processes. This results in timelier decisions, better resource utilization, and improved compliance.
Denials prevention starts with upstream controls. NewgenONE enables pre-bill validations, real-time alerts, and coding validations using BPM and AI. For denials resolution, automated workflows streamline appeals, while integrated CCM tools generate and track personalized payer correspondence. Historical data and machine learning help identify denial patterns and root causes, informing continuous process improvement.
Unlike point solutions, NewgenONE unifies ECM, BPM, and CCM in a single low-code, AI-powered platform. This integration allows healthcare providers to centralize records, orchestrate complex processes, and automate patient and payer communications—delivering transparency, compliance, and speed at scale.
- Improved CDI accuracy and DRG compliance
- Timely UM reviews with automated decision support
- Reduced denial rates through proactive controls and rapid resolution
- Seamless integration with existing clinical and billing systems
- Scalable, configurable platform tailored to your health system’s needs
As health systems look to modernize their revenue cycle and clinical operations, platforms like NewgenONE offer a strategic advantage. With a unified approach to documentation, utilization, and denials, NewgenONE delivers intelligent automation that aligns teams, streamlines processes, and maximizes outcomes.
GHIT Digital ( https://ghit.digital/) is a domain focused, future ready, Enterprise Software Product Implementation, IT Services & Digital Transformation firm. We are Minority and Women Owned (MWOB) small business from New Jersey, USA. Diversity, Inclusion, and Growth is our Mantra. Team GHIT works on strategic IT Projects for Government (G); HealthCare (H); Insurance (I); and Technology (T) clients, thus the brand GHIT. We are nimble, scalable and sell & deliver with Platform Partners & Delivery Partners. Our niche capabilities include Agile Project Management, Infrastructure Services, Data Services, Cloud native Data and Implementation, Integration, Migration, & Optimization of AI Powered, LowCode NewgenOne EDM, BPM, CCM, ANG and PLM Software Products & Platforms.
MonMass, Inc. (the legal name of GHIT Digital) will work on your strategic IT Projects or Consulting requirements (NAICS codes 541511 / 541512 / 541330 / 541618). Feel free to call 201.792.8924 or 646.734.6482 or write to me at Monika@GHIT.digital for no obligation discovery conversation. You are welcome to share your RFPs/RPQs for us to review and respond on time.
Monika Vashishtha, MBA, ITIL, PMP
President
https://ghit.digital I Monika@GHIT.digital
Government | Health | Insurance | Tech
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