Provider Communication Management

The foundational product for NaviNet Insurer Connect, Provider Communication Management is the primary channel for communication between health plans and providers, offering a platform for health plans from which to expand the provider dialogue. This product offers several fundamental transactions, such as:

Eligibility and Benefits Searches—Allows providers and their staff access to real-time, detailed eligibility and benefit information for any member, eliminating the need to call the health plan directly and allows users to check eligibility during the initial patient phone call, upon patient registration at the office or prior to claim submission.

Claims Status Inquiries—Equips users to view real-time, detailed claims information for a particular member or provider, without having to contact the health plan. Users can also print and send this information to another health plan, when secondary insurance applies.

Doc Xchange—Enables users to share clinical documents to support the submission and validation of claims or other clinically-oriented documentation need. With this capability, bi-directional communication and document sharing can be facilitated between payers and providers, providers and providers, as well as providers and other healthcare constituents, such as pharmacy benefits managers (PBMs).

Provider Messaging—Manages communication between health plans and providers through the NaviNet Message Center, through several NaviNet communication channels including Plan Central and Action Items.

For more information on Provider Communication Management, please contact us.