Within a few short months, almost 60 percent of our provider network had already begun communicating with us via NaviNet.
» Ed Malinowski, Associate Vice President, AmeriHealth Mercy
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Insurer Connect gives provider office staff secure, real-time access to the most current member eligibility and benefit information. Our solutions present increasingly complex benefit information in a straightforward manner, ensuring better patient communications and fewer calls to insurers.
AmeriHealth Mercy Family of Companies has success with NaviNet Insurer Connect
The AmeriHealth Mercy Family of Companies (AmeriHealth Mercy) comprises the largest family of Medicaid managed care plans in the United States, touching the lives of more than 6.2 million members. With products in 13 states across the country, AmeriHealth Mercy is an expert and industry leader in Medicaid, State Children’s Health Insurance Programs (SCHIP) and other publicly funded insurance programs.
Business Challenge
AmeriHealth Mercy had a provider Web portal that made basic administrative transactions available electronically to providers doing business with multiple lines of business (LOB) across five states. While the portal was successful, maintaining and upgrading it was a time- and resource-intensive task. To improve its provider portal, AmeriHealth Mercy sought a solutions partner that could:
• Show core competency in healthcare Web communications
• Provide fast, cost-effective development solutions
• Support AmeriHealth Mercy’s national business development strategy
• Support each LOB’s unique back office, electronic processes and unique state issues
• Provide a Web portal that was quick to market
• Offer significant provider adoption success across the country
• Deliver a platform with which the majority of its providers were already familiar
Solution
AmeriHealth Mercy selected NaviNet to develop an improved provider portal based on its proven solutions, services, expertise and innovation. NaviNet’s multi-payer Web portal already linked over 770,000 providers, including much of AmeriHealth Mercy’s provider network, with leading health plans in all 50 states.
NaviNet’s unique delivery methodology, which addressed every facet of the development process in an iterative manner, allowed AmeriHealth Mercy to inspect development cycles as they were being built and provided NaviNet the opportunity to respond to AmeriHealth Mercy’s feedback more efficiently.
NaviNet achieved parity with AmeriHealth Mercy’s existing portal and built new transactions for two of AmeriHealth Mercy’s health plans in just 120 days. In the next 90 days, NaviNet launched the new functionality state-by-state to four additional health plans.
The successful NaviNet implementation included:
• Development of NaviNet eligibility and claims status inquiry transactions that mirrored the plans’ legacy transactions
• Standardization of AmeriHealth Mercy’s real-time gateway across its multiple LOBs
• System-to-system real-time interfaces against AmeriHealth Mercy’s back-end Facets system and its public Web portal
• An upgrade of both the user interface and business logic to add user-friendly features and enhanced search capabilities
• Creation of a new administrative transaction to assist in claims for complex patient care
The NaviNet solution also branded portals for each LOB and populated them with LOB-specific logos, messaging and information. NaviNet addressed security concerns by implementing the NaviNet multi-payer security model across all of the company’s health plans, providing industry-leading security while being virtually transparent to users.
“NaviNet’s expertise and experience in payer-provider communications were critical in helping us to most effectively develop and deploy our NaviNet Web portal, promote its availability and benefits to our provider network, and surpass our ROI goals.” said Ed Malinowski, associate vice president, AmeriHealth Mercy. “Within a few short months, almost 60 percent of our provider network had already begun communicating with us via NaviNet.”
Impact
The NaviNet portal implementation benefited AmeriHealth Mercy in several ways:
• Provided a secure provider communications Web portal in an accelerated timeframe
• Enabled AmeriHealth Mercy to accelerate the shutdown of its legacy provider portal
• Addressed nuances at the state level for each LOB, such as naming conventions and customizations particular to each state
• Supported AmeriHealth Mercy’s continuing business development efforts with the ability to integrate new health plans onto NaviNet with minimal impact to current business functions
• Provided the ability to offer new functionality such as clinical messaging and alerts
• Freed AmeriHealth Mercy’s IT resources to concentrate on core business and launch new technical initiatives
With NaviNet, AmeriHealth Mercy has realized higher portal utilization, significant return on investment and increased satisfaction among its provider community. Only eight months after implementing NaviNet, AmeriHealth Mercy’s electronic transactions increased by 35 percent.
“Having AmeriHealth Mercy on NaviNet made our office more efficient. Being able to process our transactions for different insurance plans through one portal ultimately provides better service to our patients,” said Lisa Carrigan, office manager for Stephen G. Diamantoni Associates in Lancaster, PA. “I wish all of our health plans would switch to NaviNet.”
In the future, AmeriHealth Mercy plans to launch NaviNet clinical functionality, which will deliver even more value to its provider network and further improve member care.
