Provider Lifecycle Management

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. Leverage the Provider Lifecycle Management Solution to create all types of provider contracts, including value-based, self-service for providers, lead management for networking teams, and a seamless onboarding and maintenance process.

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Newgen’s Provider Lifecycle Management Solution

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Digital Transformation of Provider Ecosystem with Newgen’s Provider Lifecycle Management Solution

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Newgen’s Provider Lifecycle Management Solution

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End-to-end Digital Automation—Contracting to Claims Processing

Newgen Provider Contract and Network Manager

Contract Lifecycle Management

Contract Automation

Credentialing

Operations

Features

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

OPERATIONAL BENEFITS OF NEWGEN’S PROVIDER LIFECYCLE MANAGEMENT

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

Frequently Asked Questions

Why should a health plan implement the Provider Lifecycle Management Solution?

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

What are the areas of provider management that Newgen automates?

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

What are the reporting capabilities of Provider Lifecycle Management Solution?

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.

Does Provider Lifecycle Management Solution have an online application portal?

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

Does the Provider Lifecycle Management Solution integrate with other systems?

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

How does the Newgen Solution handle customer Provider Data Management (PDM) systems?

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.

Can Provider Lifecycle Management Solution be customized based on the specific needs of health plans?

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.

Is the Provider Lifecycle Management Solution hosted on the cloud?

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

Does the Provider Lifecycle Management Solution have document storage and content management capabilities?

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