Digital. Dynamic. Dependable.
Provider Lifecycle Management
Stay current, competitive, and expansion-ready in contracting, credentialing, configuration, provider data management (PDM), and provider self-service.
Expedite onboarding and maintenance of providers into your network. Take advantage of the comprehensive suite of AI-powered solutions that cover every aspect of the provider’s journey while ensuring seamless operations. Use the contract initiation and management tools, manage agreements across departments, and create value-based contracts (VBC) while gaining a competitive edge.
Utilize the low-code framework of the platform that’s completely interoperable with your additional departmental applications, thereby ensuring cohesive and efficient system integration. Configure workflows and data fields that comply with NCQA, federal, and state regulations, aligning them with your specific business needs and operations. Offer self-service options for your providers, allowing them to submit their data and make changes within the portal, speeding up onboarding processes. Additionally, take advantage of the built-in rules for automating workflows and validations, thereby reducing turnaround time (TAT) and enhancing overall operational efficiency.
Core Components of Provider Lifecycle Management Solution
AI Driven – Innovative Features of Provider Life Cycle Management
Contract and Document Summarization with Marvin AI
Summarize contracts with the click of a button using Marvin. Optimize and streamline the contracting, credentialing, and configuration process by asking questions and receiving suggestions. All questions and responses are recorded for future reference.
Value-based Contracting & Non-Standard Risk Scoring in Contracting with AI
Enable value-based contracting and non-standard risk scoring with AI. Analyze complex contracts using built-in risk scoring algorithm, encompassing a combination of network access, rates, provider history scorecard, quality, provider profile, and more
Chatbot on Provider Portal with Marvin AI
Allow providers to ask questions, get directed to call center, learn more about the provider portal, and chat with a provider relations representative through Marvin AI
Value-based Contract Creation
Create complex value-based contracts that consider quality, efficiency, error rate, compliant, Stars/HEDIS, financial (RCM) and more. Achieve higher quality care and better health outcomes for members
Contract and Document Summarization with Marvin AI
Summarize contracts with the click of a button using Marvin. Optimize and streamline the contracting, credentialing, and configuration process by asking questions and receiving suggestions. All questions and responses are recorded for future reference.
Value-based Contracting & Non-Standard Risk Scoring in Contracting with AI
Enable value-based contracting and non-standard risk scoring with AI. Analyze complex contracts using built-in risk scoring algorithm, encompassing a combination of network access, rates, provider history scorecard, quality, provider profile, and more
Chatbot on Provider Portal with Marvin AI
Allow providers to ask questions, get directed to call center, learn more about the provider portal, and chat with a provider relations representative through Marvin AI
Value-based Contract Creation
Create complex value-based contracts that consider quality, efficiency, error rate, compliant, Stars/HEDIS, financial (RCM) and more. Achieve higher quality care and better health outcomes for members
Business Benefits of Provider Lifecycle Management Solution
Minimized Turnaround Time (TAT)
Run frictionless operations and streamline processes to ensure prompt responses to providers’ needs and regulatory requirements. Reduce manual tasks and eliminate bottlenecks to create smoother workflows, thereby maximizing operational efficiency and minimizing TAT for critical processes
Improved Star Rating and State Incentives
Achieve favorable ratings with three or more stars, encouraging bonus payments as incentives for delivering quality care and enhancing patient satisfaction. Ensure consistency and accuracy in ratings, improving your goodwill and trust among providers
Better HEDIS and NCQA Results
Get financial rewards for exceeding score thresholds in HEDIS metrics and encourage initiatives for better health outcomes. Improve HEDIS metrics to secure better incentives for providers and insurers, promoting smooth collaboration and alignment towards shared objectives. Meet all the required NCQA standards for onboarding and maintaining the provider’s data
Market Scalability
Operate efficiently across states and products through a unified platform to minimize administrative complexities, enhance market scalability. Incorporate multiple product ingredients and apply smart rules to adopt to changing market demands and regulations, facilitating sustained growth through market expansion
Minimized Turnaround Time (TAT)
Run frictionless operations and streamline processes to ensure prompt responses to providers’ needs and regulatory requirements. Reduce manual tasks and eliminate bottlenecks to create smoother workflows, thereby maximizing operational efficiency and minimizing TAT for critical processes
Improved Star Rating and State Incentives
Achieve favorable ratings with three or more stars, encouraging bonus payments as incentives for delivering quality care and enhancing patient satisfaction. Ensure consistency and accuracy in ratings, improving your goodwill and trust among providers
Better HEDIS and NCQA Results
Get financial rewards for exceeding score thresholds in HEDIS metrics and encourage initiatives for better health outcomes. Improve HEDIS metrics to secure better incentives for providers and insurers, promoting smooth collaboration and alignment towards shared objectives. Meet all the required NCQA standards for onboarding and maintaining the provider’s data
Market Scalability
Operate efficiently across states and products through a unified platform to minimize administrative complexities, enhance market scalability. Incorporate multiple product ingredients and apply smart rules to adopt to changing market demands and regulations, facilitating sustained growth through market expansion
Success Stories
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Frequently Asked Questions
The Provider Lifecycle Management Solution 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 Lifecycle Management Solution 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 time
- Expedited loading of provider’s information which ensures processing to the contracted rate as soon as possible and online provider directory accuracy
Newgen’s Provider Lifecycle Management Solution helps health plans automate the following areas of provider management:
- Provider onboarding
- Provider data management
- Provider contracting
- Self-service for providers
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.
The Provider Lifecycle Management Solution 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
The Provider Lifecycle Management Solution integrates with various systems, including:
- CAQH, NPPES, and State Files for onboarding
- Credentialing and verification systems
- Salesforce and other lead management systems
- Provider Data Management (PDM) systems
- Claim systems
- Provider directories
The Provider Lifecycle Management Solution has 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.
The Provider Lifecycle Management Solution 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.
Newgen’s Provider Lifecycle Management Solution is available on the cloud and on-premises configurations based on specific needs.
The Provider Lifecycle Management Solution leverages Newgen’s Contextual Content Services (ECM) platform, which includes a document storage repository.
