Navigate new care delivery models, complex regulations, and simplify provider networks by automating your complete provider ecosystem. Ensure adherence with compliance requirements and eliminate the risk of financial penalties. Utilize the Provider Lifecycle Management Solution to facilitate the creation of diverse provider contracts, encompassing value-based agreements. Empower providers with self-service capabilities, efficiently manage provider data, and establish a seamless process for onboarding and ongoing maintenance. This comprehensive solution ensures a streamlined and dynamic approach to provider management within the healthcare ecosystem.

Features of Newgen Provider Lifecycle Management Software

Simplified Provider Self-service

Standardized network submissions

Automated smart rules and complex business logic

Provider transparency, visibility, and ownership of their data

Bulk submissions of provider loads

Transparent processing with provider dashboard

Real-time notifications for users

Seamless Onboarding and Maintenance

Multifaceted process, encompassing all types of requests within one platform

Departmental routing based on smart rules

Integration with state and federal agencies

Segregated roles and responsibilities

Predictive analytics and dashboard reporting for better visibility and transparency

Integration with health plans’ core systems for automated data transfers

Streamlined processes backed with robotic process automation (RPA)

Intelligent Contract Creation and Management

Automated contract creation process and interview-based contracting capability

Intelligent questionnaire to generate contracts using pre-defined templates

Parallel editing, bind variables, reusable clauses, and templates to expedite the contract creation process

Easy incorporation of changes in state and federal regulations

Comprehensive Communication Management

Event-based triggers to timely distribute communications, including welcome, termination, and denial letters

Provider follow-up capabilities in case of exceptions or discrepancies

Call logs, site notes, and issue tracking

Multi-channel distribution and tracking

Robust integration with business applications, core systems, portals, etc.

Secure Document Archival and Access

Centralized archival of contract data and documents

Role-based user access to centralized contract repository

Extensive search capability

Numerous document formats

External Integration and Data Capture

Core claims, credentialing, provider networking, and third-party system integration

Data capture from third-party system using out-of-the-box APIs, allowing for seamless data exchange across systems

Benefits of Newgen Provider Lifecycle Management Software

Improve Star Rating

  • Plans with three or more stars receive annual bonus payments from the CMS
  • Consistency and accuracy, leading to improved ratings

Boost HEDIS/State Incentives

  • Significant financial incentives for providers and insurers if a score exceeds a certain threshold
  • Improvement of scores and HEDIS score metrics

Enhance Market Scalability

  • Single unified platform that can be leveraged across multiple states and products
  • Multiple product ingredients
  • Smart rules can be applied and leveraged

Reduce Turn Around Time

  • Streamlined process
  • Removal of manual tasks
  • Bottleneck-free process

Improve Star Rating

  • Plans with three or more stars receive annual bonus payments from the CMS
  • Consistency and accuracy, leading to improved ratings

Boost HEDIS/State Incentives

  • Significant financial incentives for providers and insurers if a score exceeds a certain threshold
  • Improvement of scores and HEDIS score metrics

Enhance Market Scalability

  • Single unified platform that can be leveraged across multiple states and products
  • Multiple product ingredients
  • Smart rules can be applied and leveraged

Reduce Turn Around Time

  • Streamlined process
  • Removal of manual tasks
  • Bottleneck-free process

All you need to know about Provider Lifecycle Management

The Provider Lifecycle Management Solution enhances the entire spectrum of interactions between payer and provider. A functioning ecosystem has connected processes and secure provider data for payer integration, enabling seamless provider management. The Provider Lifecycle Management Solution helps deliver a seamless experience to providers by facilitating:

  • The self-service portal for contracting, provider onboarding submissions, and data maintenance
  • Distribution of personalized, real-time communications (notifications, account information, etc.)
  • Data ownership with information submitted directly from the user
  • Elimination of manual processes, thereby avoiding chances of the inaccuracy of data into core systems
  • Robotics process automation, machine learning, and artificial intelligence capabilities within the provider ecosystem for agile automation and faster turnaround time
  • Expedited loading of provider’s information which ensures processing to the contracted rate as soon as possible and online provider directory accuracy

Newgen’s Provider Lifecycle Management Solution helps health plans automate the following areas of provider management:

  • Provider onboarding
  • Provider data management
  • Provider contracting
  • Self-service for providers

Health plans need detailed reporting to understand the end-to-end turnaround times, manage production/performance, and adhere to compliance regulations. NewgenONE Digital Transformation Platform has intuitive, agile, and robust reporting capabilities.

The Provider Lifecycle Management Solution has a full self-service portal that allows:

  • Simplified online contracting experience
  • Provider onboarding by a single entry or bulk loads
  • Provider data modifications to existing providers
  • Tracking and status updates of service requests
  • Access to contracts and welcome letters

The Provider Lifecycle Management Solution integrates with various systems, including:

  • CAQH, NPPES, and State Files for onboarding
  • Credentialing and verification systems
  • Salesforce and other lead management systems
  • Provider Data Management (PDM) systems
  • Claim systems
  • Provider directories

The Provider Lifecycle Management Solution has an orchestration layer over existing PDM solutions where data input gets modified in the PDM based on the information submitted through our onboarding and data maintenance modules. The orchestration layer provides management of requests and allows for archival of changes added or modified in the PDM.

The Provider Lifecycle Management Solution is fully customizable based on specific health plans and product needs. Our low code application platforms (LCAP) allow fast and seamless modifications in line with the exact compliance and internal needs.

Newgen’s Provider Lifecycle Management Solution is available on the cloud and on-premises configurations based on specific needs.

The Provider Lifecycle Management Solution leverages Newgen’s Contextual Content Services (ECM) platform, which includes a document storage repository.