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.

 -  - Provider Ecosystem

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 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