Modern Provider Contracting for the Modern World

Redefining Provider Networks for Speed, Compliance, and Efficiency

Healthcare payers today are navigating a perfect storm — rising member expectations, evolving regulations, and the shift toward value-based care. At the heart of this complexity lies one crucial lever of efficiency and compliance — provider contracting.
Provider contracts determine how health plans engage with care providers, define reimbursement terms, and ensure quality outcomes. Yet, many organizations still manage these contracts through manual, paper-based, and siloed processes, leading to operational delays, compliance challenges, and rising costs.
This eBook explores how health plans can modernize their provider contracting processes to achieve speed, standardization, and strategic advantage through automation and digital transformation.

The Shifting Landscape of Provider Contracting

Health plans are under increasing pressure to deliver high-quality care while keeping administrative costs in check. With expanding member bases, regulatory demands, and the rise of digital-first healthcare, outdated contracting methods are no longer sustainable.

Key Trends Driving Change

• Aging Populations: Growing healthcare demands and the need for personalized services.
• Evolving Regulations: Heightened federal and state compliance requirements.
• Membership Expansion: Rapidly growing networks and data complexity.
• Value-Based Contracting: A shift toward performance-driven reimbursements.

The role of provider contracts has evolved from being an administrative function to a strategic business lever impacting everything from claims accuracy to member satisfaction.

The Three Core Challenges

Despite best intentions, most health plans face three persistent challenges:

1. Siloed Systems and Processes
   Contracting requires collaboration across multiple departments — from relationship management to credentialing and configuration. However, disconnected systems lead to data duplication, manual re-entry, and workflow delays, resulting in longer turnaround times and higher costs.

2. Physical Documentation
   Paper-based contracts slow down approvals, increase risk, and create storage challenges. Errors, misplaced documents, and reprints add to administrative overheads, making it nearly impossible to scale or maintain audit readiness.

3. Manual and Error-Prone Processes
   Manual data entry, spreadsheet-based calculations, and offline reviews cause delays and inconsistencies. These inefficiencies lead to compliance issues, version mismatches, and reporting gaps, reducing process reliability.

The result is a contracting cycle that takes 60 to 180 days or more, increasing operational costs and jeopardizing provider satisfaction.

The Digital Imperative

As Gartner highlights, “Digitalization has moved from an innovation trend to a core competency.”
Health plans must now align with the digital imperatives of speed, transparency, and member experience.

The New Business Priorities

1. Delight Customers: Every provider and member interaction must be timely, consistent, and seamless.
2. Move Faster: Health plans must be able to respond instantly to regulatory or network changes.
3. Enable Anywhere Work: Digitally connected systems empower remote collaboration and efficiency.

Simply put, modernization is no longer a choice — it’s a strategic necessity for survival and growth.

The Five-Point Action Plan for Modern Provider Contracting

To thrive in the modern healthcare landscape, health plans must transform provider contracting from a backend process into a strategic business enabler.

1. 1. Automate the End-to-End Contract Lifecycle

Integrate all stages — from contract creation to renewal — into a unified, automated workflow.

• Replace manual hand-offs with Business Process Management (BPM) systems.
• Enable real-time dashboards to track contract status and SLAs.
• Integrate front-end and back-end systems for straight-through processing.

Outcome: Reduced turnaround time, fewer errors, and improved compliance.

1. 2. Empower People with Digital Tools

Equip every stakeholder — from relationship managers to configuration teams — with the right tools to work efficiently.

• Use case management for flexibility and exception handling.
• Enable on-the-go approvals through mobility.
• Provide role-based dashboards for transparency and accountability.

Outcome: Faster decision-making and a collaborative digital workplace.

1. 3. Improve Turnaround Time and Revenue Realization

Streamline contract creation, approval, and execution processes.

• Automate document generation and digital signatures.
• Parallelize tasks to reduce waiting time between departments.
• Ensure seamless integration between contracting and claims systems.

Outcome: Contracts executed up to 35% faster, enabling faster provider activation and revenue growth.

1. 4. Strengthen Compliance and Risk Management

Modern contracting platforms embed compliance into every stage of the process.

• Automate policy enforcement through Business Rules Management Systems (BRMS).
• Maintain audit trails for all contract modifications.
• Ensure transparency and traceability across teams and regions.

Outcome: A 95% improvement in compliance, as reported by Newgen’s healthcare clients.

1. 5. Build Agility for Rapid Adaptation

Healthcare is dynamic — policies, pricing, and provider networks change frequently.

• Use low-code process frameworks to enable quick updates to workflows.
• Decouple business rules from process logic for flexibility.
• Reconfigure systems rapidly to accommodate new reimbursement models.

Outcome: Improved responsiveness to market and regulatory shifts, ensuring long-term agility.

Measurable Results — The Newgen Impact

“Our turnaround times reduced by 35%, operational costs cut down by 40%, and overall compliance improved by 95%.”
— Renee Santana, Director, Corporate Initiatives, Wellcare Health Plans

Health plans leveraging Newgen’s Provider Contracting Solution have reported:

• 40% cost reduction through automation and process optimization.
• 35% faster contract turnaround through workflow integration.
• 95% compliance accuracy with built-in policy automation.

The All-Round Advantage of Digital Provider Contracting

A modern, AI-powered contracting system delivers tangible business value across multiple dimensions:

• Process Standardization: Eliminate manual data entry and inconsistencies.
• Auto-Routing: Ensure instant contract routing between departments.
• Audit History: Maintain comprehensive digital logs for transparency.
• Monitoring Dashboards: Gain real-time visibility into contract status and metrics.
• Streamlined Communication: Reduce miscommunication through digital collaboration templates.
• Simplified Content Management: Automatically capture and attach supporting documents, reducing errors.

Outcome: A faster, more compliant, and more connected provider ecosystem.

Why Choose Newgen?

With decades of domain expertise, Newgen’s Provider Contract Management Solution helps health plans transform their contracting ecosystem into a digital, agile, and compliant powerhouse.

Key Differentiators:

• Unified low-code automation platform for healthcare operations.
• AI-powered content and process management for greater accuracy.
• Cloud-ready, scalable architecture supporting remote collaboration.
• Proven success with leading global health plans.

Newgen’s solution ensures operational efficiency, faster provider onboarding, and long-term regulatory alignment — enabling health plans to stay ahead in a dynamic healthcare landscape.

Begin Your Digital Provider Contracting Journey
Future-proof your health plan with automation, compliance, and agility.