Provider Ecosystem

Enable faster, accessible, and high-quality service to your Providers

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  - Provider Ecosystem

Navigate new care delivery models, and complex regulations, and simplify provider networks by automating your provider ecosystem. Ensure adherence to compliance requirements and eliminate the risk of financial penalties. Our Provider Ecosystem Accelerator allows for the creation of 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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Watch Webinar #1

Digital Transformation of Provider Onboarding with NewgenONE Platform

 - Watch Webinar #2 - Provider Ecosystem
Watch Webinar #2

Digital Transformation of Provider Ecosystems with Newgen’s Provider Ecosystem Accelerator

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Newgen Provider Ecosystem Accelerator

Provider Ecosystem Accelerator - Download Infographic - Provider Ecosystem
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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

Provider Ecosystem

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)
Provider Ecosystem

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.
Provider Ecosystem

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 Ecosystem

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 Ecosystem Accelerator?

The Provider Ecosystem Accelerator 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 Ecosystem Accelerator 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 times
  • 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 Newgen automates?

Newgen’s provider system accelerator 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 Ecosystem Accelerator?

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 Ecosystem Accelerator have an online application portal?

The Provider Ecosystem Accelerator 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 Ecosystem Accelerator integrate with other systems?

The Provider Ecosystem Accelerator integrates with various systems. The following areas are:

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

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

The Provider Ecosystem Accelerator Ecosystem is 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 Ecosystem Accelerator be customized based on Health plan specific needs?

The Provider Ecosystem Accelerator 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 Ecosystem Solution hosted on the cloud?

Newgen’s Provider Ecosystem Accelerator is available on the cloud and on-premises configurations based on specific needs.

Does the Provider Ecosystem have document storage and content management capabilities?

The Provider Ecosystem Accelerator uses Newgen’s Contextual Content Services (ECM) platform, which includes a document storage repository.