Navigate new care delivery models, complex regulations, and simplify provider networks by automating your complete provider ecosystem. Ensure adherence with compliance requirements and eliminate the risk of financial penalties. Leverage the Provider Lifecycle Management Solution to create all types of provider contracts, including value-based, self-service for providers, lead management for networking teams, and a seamless onboarding and maintenance process.

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
Compliance and Data Security
  • 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 INVIQA’S PROVIDER LIFECYCLE MANAGEMENT
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

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

Inviqa’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. InviqaONE 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.

Inviqa’s Provider Lifecycle Management Solution is available on the cloud and on-premises configurations based on specific needs.

The Provider Lifecycle Management Solution leverages Inviqa’s Contextual Content Services (ECM) platform, which includes a document storage repository.