Digital. Dynamic. Dependable.
Optimize Provider Network & Relationship Management to Maximize Value
Accelerate deployment and strengthen provider relationship; leverage the modular solution to rapidly configure workflows and integrations without deep coding. Manage the full spectrum, from onboarding and credentialing to contracting and performance, in one connected system. Easily support Medicaid, Medicare, ACA, and Commercial lines of business. Utilize robust, built-in capabilities that help you scale as you grow, delivering top-tier performance while ensuring compliance.
Learn What Provider Network & Relationship Management Solution Can Do for You?
Provider Network Analytics and Real-time Intelligence
Use real-time network adequacy monitoring to generate adequacy scorecards and interactive heatmaps, tracks compliance with geo-access and time-distance standards automatically, and send automated alerts
Run provider termination and replacement workflow to execute transition plans, trigger member movement notifications, and recalculate panel adequacy for PCP replacement
Manage provider panels and PCP rosters with automated adequacy checks, real-time panel status updates, and instant visibility into network impact
Leverage analytics dashboards to view real-time provider performance, adequacy, and referral patterns, uncovering opportunities to optimize the network
AI-powered Onboarding, Engagement and Compliance
Accelerate provider recruitment, onboarding, and credentialing, thereby reducing time to network participation
Centralize all provider data in a single, audit-ready provider data repository for simplified compliance and data management, including accessibility, cultural, and linguistic attributes
Build stronger partnership with automated provider scorecards, feedback loops, and value-based care tracking tools
Resolve issues efficiently using automated workflows for issue/complaint management with transparent resolution paths
Maintain accurate provider directories with proactive validation and complete audit trails
Provider Search and Discovery
Search flexibly by specialty, subspecialty, zip code, county, or rural/urban classification
Match precisely using panel status, appointment availability, geo-access, and member scoring
Navigate intuitively with interactive maps and guided specialty options
Automated Provider Communications and Outreach
Roll-out multi-channel communications via email, SMS, portal, and in app, fully tracked for confirmations and engagement
Manage targeted campaigns and personalized engagement
Power recruitment workflows powered with AI-based targeting and matching from NPPES/CAQH data, including full activity tracking
Relationship Tracking & Management
Engage providers across multiple channels, including calls, emails, meetings, and notes, while monitoring all confirmations
Automate the majority of your messaging using AI to significantly improve response rate
Launch and manage targeted campaigns with personalized communications
Optimize recruitment, streamlining the process from onboarding to ongoing management in a single unified platform
Robust Ecosystem
Integrate natively with essential systems, including CAQH, NPPES, and state licensing boards
Automate compliance checks against OIG exclusion lists and credentialing databases
Sync data seamlessly across contract management, provider directories, and address validation services
Strong Integrations
CAQH | NPPES | OIG Exclusion Lists | State Licensing Boards | Contracting, PDM & Credentialing Systems | Provider Directories | Address Validation Services | Communication Platforms | Compliance Databases
Key Benefits: Newgen vs. Typical PNRM Systems
| Approach to Innovation | Typical PNRM (Legacy, Static) | Newgen (AI-first, Low-code) |
|---|---|---|
| Platform Footprint | Multiple disconnected systems require heavy integration | A unified platform replaces 4–6 siloed tools |
| Network Adequacy Monitoring | Static quarterly/annual reports with limited visibility into adequacy gaps | Real-time adequacy scorecards, geo-access, time-distance analysis, and automated breach alerts |
| Provider Termination & Replacement | Manual reassignments with delayed adequacy recalculation | Automated PCP replacement triggers, transition planning, and member notifications |
| Provider Search & Recruitment | Manual provider searches and inconsistent recruitment tracking | AI-driven targeting from NPPES/CAQH, specialty/sub-specialty mapping, end-to-end recruitment workflows |
| Provider Directory Accuracy | Outdated, siloed directories with high error rates | Centralized, audit-ready directory with accessibility, cultural, and linguistic attributes |
| Provider Engagement & Communication | Manual calls/emails; low response; high admin efforts | AI-driven multi-channel outreach automates 70–80% of communications; higher provider response rates |
| Multi-line-of-business | Separate program-specific systems with duplicate maintenance | Single environment supports Medicaid, Medicare, ACA, Commercial, avoiding 2-3x higher cost |
| Workflow Agility | Custom IT development takes 4–6 months | New processes and updates configured in 2–4 weeks via low-code capabilities |
| Quality Programs | Reactive handling with limited quality impact | Proactive provider scorecards & feedback loops improve STAR/HEDIS by 3–5 points annually |
| Compliance-readiness | Manual checks, requiring months of preparation | Embedded NCQA, CMS, URAC compliance; reduces audit prep by 60–70% |
