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Transforming Provider Credentialing with Intelligent Orchestration
Automate primary source verification, board certification checks, and sanctions screening with accuracy. Manage the full credentialing process from application intake to committee review with oversight, compliance, and speed.
“Newgen’s Provider Credentialing and Configuration Software helped us reduce credentialing turnaround time by 50% and improved compliance adherence by 40%.”
– Chief Operations Officer, A Renowned Health Plan
Learn What Newgen’s Provider Credentialing and Verification Software Can Do for You
Credentialing Verification with Scalable Business Logic
Automate the complete process for accuracy and efficiency. Receive real-time updates on verification status for timely decision-making. Integrate with the latest verification sources, including Medicaid state files, license websites, SAM.GOV, preclusion list, OIG, SSN death master, CLIA, PECOS, CAQH, NPPES, DEA, JCAHO, NPDB, and address validations. Adapt to changing NCQA, CMS, and state rules. Use the system’s low code capability for easy adjustments.
Roster Automation and Document Management
Provide a secure repository with robust tracking capabilities for all provider-related documents, enabling seamless uploading, organization, and retrieval while storing files alongside provider records or in groups. Streamline processes by transforming unstructured provider rosters into standardized formats, automating data integration into credentialing, configuration workflows, and provider data management (PDM) systems for enhanced efficiency and compliance.
Return to Provider
Facilitate seamless communication by transferring questions or requests for additional information, to a provider. Leveraging the return-to-provider capability to request more information, documents, or clarification about the provided data.
Application and Onboarding
Streamline electronic forms and workflows for faster onboarding. Enhance collaboration among stakeholders during the application process. Simplify provider credentialing and automate notifications.
Privileging and Credentialing Committee Management
Provide access to a centralized platform for transparent committee collaboration and decision-making. Access relevant information and documentation for informed decision making.
Provider Correspondence/Letters
Send correspondence and letters based on NCQA, CMS, State, or your requirements. Ensure providers receive transparent information.
Provider Lifecycle Management: Buy All-in-one Pack or Choose an Individual Solution
Explore Other Solutions for the Payer-Provider Journey
Claims Automation
Streamline claims with an AI-driven, low-code automation process
Provider Relations and Complaints
Enhance provider relationships while streamlining communications and driving a collaborative environment
SIU & FWA Case Management
Detect and address fraud while enhancing efficiency and ensuring compliance
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Frequently Asked Questions related to Provider Credentialing
Provider credentialing is the process of verifying a healthcare provider’s qualifications, including education, training, licensure, and work history to ensure they are competent and legally eligible to provide care.
Newgen’s provider credentialing solution automates the end-to-end lifecycle from application intake to primary source verification, using AI for document classification, data extraction, and real-time monitoring. This reduces errors, speeds up onboarding, and ensures regulatory compliance.
Credentialing involves collecting provider documents, verifying credentials with primary sources, assessing background and experience, and reviewing for regulatory compliance before granting clinical privileges or payer participation.
Newgen’s credentialing management software deploys AI/ML and RPA to replace manual verification steps. It integrates with CAQH, NPPES, OIG, and state Medicaid lists, automatically validating data and flagging discrepancies. Providers and payers gain faster, more accurate credentialing.
Yes. APIs, file-based exchanges, and RPA bots ensure that credentialing results flow seamlessly into provider data management, contracting, and enrollment systems.
Newgen uses AI-powered alerts and RPA-driven checks to continuously monitor licenses, sanctions, and exclusions in real-time, reducing compliance risks.
AI auto-generates audit trails, maintains verification logs, and provides compliance dashboards aligned with NCQA and CMS requirements. Health plans can produce audit-ready evidence at any time.
By cutting credentialing cycle times, reducing admin workload, and improving compliance, Newgen’s solution delivers rapid ROI. Use the Newgen PLM ROI Calculator to see estimated savings.
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