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Attend to broader healthcare and prioritize provider lifecycle management – beyond contracting, credentialing, and onboarding. Leverage our comprehensive suite of AI-powered solutions that cover every aspect of the provider journey while ensuring seamless operations. With our contract initiation and management tools, manage agreements across departments, thereby minimizing administrative overheads. Customize workflows and data fields while aligning them precisely with your requirements. Offer self-service options for your providers, allowing them to submit their data and make changes within the portal, speeding up onboarding processes. Additionally, leverage the built-in rules for automating workflows and validations, thereby reducing turnaround time (TAT) and enhancing overall operational efficiency.

Core Components of Provider Lifecycle Management Solution

Provider Data Management (PDM)

Keep a well-organized ‘address book’ of providers in the network for superior member experience and ensure compliance with the ‘No Surprises Act’.

Provider Configuration & Credentialing Management (PCM)

Perform fast and accurate due diligence on provider quality and performance before inducting them into the network.

Provider Network/Contract Management

Streamline the end-to-end process while creating a high-performing network of hospitals, clinics, physicians, and specialists

Provider (Self-service) Portal Management

Manage the entire lifecycle of the provider’s engagement and performance with the payer organization and members.

Features of Provider Lifecycle Management Solution

Introduction and Onboarding

  • Guided form introductions to ensure intuitive, efficient, and error-free processes
  • Welcome letters for new providers with personalized letters displayed on their dashboard
  • On-demand tutorials and resources for providers to address questions and enable them to gain easy access to the required information

Contracting and Credentialing

  • Automated contracting process—from initiation to finalization
  • Electronic signatures for contracts and documents, ensuring security and convenience
  • Strong credentialing process with automated verification and validation of providers

Portal Management and Self-Service

  • A centralized dashboard— an intuitive and user-friendly interface, offering providers with a detailed view of their account status and upcoming tasks
  • Easy uploading of multiple documents or input data in high volumes and different formats, such as CSV files and PDFs

Automation and Notifications

  • Automated pricing and demographic updates for accuracy and timeliness
  • Timely alerts, reminders, and notifications on the dashboard for important updates and actions

Provider Data and Directory Maintenance

  • Easy access provider directory feature for easy access to provider information
  • Archive completed cases for record-keeping and compliance purposes
  • Rights-based access to reports for maintaining the confidentiality of data

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

Introduction and Onboarding

  • Guided form introductions to ensure intuitive, efficient, and error-free processes
  • Welcome letters for new providers with personalized letters displayed on their dashboard
  • On-demand tutorials and resources for providers to address questions and enable them to gain easy access to the required information

Contracting and Credentialing

  • Automated contracting process—from initiation to finalization
  • Electronic signatures for contracts and documents, ensuring security and convenience
  • Strong credentialing process with automated verification and validation of providers

Portal Management and Self-Service

  • A centralized dashboard— an intuitive and user-friendly interface, offering providers with a detailed view of their account status and upcoming tasks
  • Easy uploading of multiple documents or input data in high volumes and different formats, such as CSV files and PDFs

Automation and Notifications

  • Automated pricing and demographic updates for accuracy and timeliness
  • Timely alerts, reminders, and notifications on the dashboard for important updates and actions

Provider Data and Directory Maintenance

  • Easy access provider directory feature for easy access to provider information
  • Archive completed cases for record-keeping and compliance purposes
  • Rights-based access to reports for maintaining the confidentiality of data

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

Business Benefits of Provider Lifecycle Management Solution

Improved Star Rating

  • Plans with three or more stars garner favorable ratings, encouraging bonus payments as incentives for delivering quality care and enhancing patient satisfaction
  • Consistency and accuracy in ratings, improving the plan’s goodwill and trust among providers

Better HEDIS/State Incentives

  • Financial rewards for exceeding score thresholds in HEDIS metrics encourage proactive measures for better health outcomes
  • Improved HEDIS metrics result in better incentives for providers and insurers, promoting smooth collaboration and alignment towards shared objectives

Market Scalability

  • Efficient operations across states and products through a unified platform minimize administrative complexities, enhancing market scalability
  • Incorporation of multiple product ingredients and application of smart rules ensure adaptability to changing market demands and regulations, facilitating sustained growth

Minimized Turnaround Time (TAT)

  • Seamless operations and streamlined processes help ensure prompt responses to providers’ needs and regulatory requirements
  • Reduction of manual tasks and elimination of bottlenecks lead to smoother workflows, thereby maximizing operational efficiency and minimizing TAT for critical processes

Improved Star Rating

  • Plans with three or more stars garner favorable ratings, encouraging bonus payments as incentives for delivering quality care and enhancing patient satisfaction
  • Consistency and accuracy in ratings, improving the plan’s goodwill and trust among providers

Better HEDIS/State Incentives

  • Financial rewards for exceeding score thresholds in HEDIS metrics encourage proactive measures for better health outcomes
  • Improved HEDIS metrics result in better incentives for providers and insurers, promoting smooth collaboration and alignment towards shared objectives

Market Scalability

  • Efficient operations across states and products through a unified platform minimize administrative complexities, enhancing market scalability
  • Incorporation of multiple product ingredients and application of smart rules ensure adaptability to changing market demands and regulations, facilitating sustained growth

Minimized Turnaround Time (TAT)

  • Seamless operations and streamlined processes help ensure prompt responses to providers’ needs and regulatory requirements
  • Reduction of manual tasks and elimination of bottlenecks lead to smoother workflows, thereby maximizing operational efficiency and minimizing TAT for critical processes

Success Stories
Featured Image

Case Study: A US-based Health Plan Transforms Operations with Newgen’s Provider Lifecycle Management Solution

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Fortune 500 Healthcare Payer Automates Appeals & Grievances Process with Newgen

Featured Image

Case Study: A US-based Health Plan Transforms Operations with Newgen’s Provider Lifecycle Management Solution

Featured Image

Fortune 500 Healthcare Payer Automates Appeals & Grievances Process with Newgen

Frequently Asked Questions

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.