NaviNet Open—Enabling Payer-Provider Collaboration Today and in the Future

NaviNet Open consists of a platform, a set of network services, a suite of applications, and a set of tools. Explore NaviNet Open | Request a Demo

NaviNet Open at a Glance

Provider Engagement and Network Effect

The timely delivery of accurate and complete information helps engage providers in meaningful exchanges at the point of care. Actionable, easy to use workflows boost adoption and utilization between providers and health plans. NaviNet Open connects all stakeholders across the network and care team with the information they need in real-time.

Integrating Clinical with Reimbursement Workflows

Enabling reimbursement transactions to trigger the delivery of rich, clinical information at the point of care is critical for improved patient outcomes. NaviNet Open listens for “events” such as eligibility checking across the provider network, identifies clinical information related to those events, and delivers that information to the provider so they can take action.

Administrative Efficiency and Usability

Portal solutions designed only to meet HIPAA standards don’t eliminate calls to your offices. NaviNet Open supports enhanced transactions that address non-standard — integrations that are robust and flexible enough to ensure providers take advantage of them.

Open Development Platform

NaviNet Open is a powerful platform for developing network-based applications. Rich API’s for accessing the platform’s capabilities, developer tools, robust provider data management and an event-based architecture round out a framework for meeting the rapidly evolving needs of increased payer-provider collaboration.

Why NaviNet Open?

Administrative Efficiency

Present richly detailed information including tiers, services and benefits - answers to all questions a provider might ask. Read more ›

Clinical Information Delivered in Real-Time

Deliver relevant, real-time clinical documents and alerts that make value-based care possible Read more ›

Flexible, Extensible Architecture

Customize, scale and extend your platform using NaviNet's open integration framework Read more ›

Full-service, Standardized Product

Lower total costs through faster implementation, predictable maintenance costs and continuous product upgrades Read more ›

Provider Engagement

NaviNet’s user-friendly, multi-payer portal has become the one-stop shop for providers Read more ›

Top-flight Customer Service

From dedicated account managers and deployment teams to training modules and 24-hour helplines, NaviNet is your full-service strategic partner. Read more ›

How It Works

NaviNet Open enables true payer-provider collaboration.

It’s All about Collaboration

  • For accountable care to be successful, health plans and providers must share not only reimbursement information, but also clinical information that impacts patient outcomes. NaviNet Open enables this critical communication to take place.
  • By 'listening' across the network, NaviNet Open detects and provides real-time actionable data, delivering the right data to the right provider, at the right time.
  • Together health plans and providers work together to improve the patient experience and achieve mutual goals.

NaviNet Open provides the critical information between health plans and providers to improve patient care.

Value-Based Reimbursement Relies on Outcomes

  • With Accountable Care, providers are reimbursed based on the value they deliver to their patients. Health plans, hospitals and Health Information Exchanges all have data sitting on servers, that can readily be used to make providers smarter. NaviNet sits in the middle of this win-win.
  • Use NaviNet Open to help provider office users act fast and deliver more targeted care for nearly 100% of patient encounters.
  • Meet the rapidly evolving needs of increased payer and provider collaboration. Health Plans get their targets met; providers get the clinical data they need to act and patients get improved care at the right time.

NaviNet Open makes value-based care an achievable result for provider offices.

Replace Your Portal

  • Much of today's healthcare information technology is behind industry mandates and imperatives. The evolving landscape demands the most accurate and complete information shared between health plans and providers. A new approach to dealing with change is needed.
  • NaviNet Open gives you a next generation multi-payer portal that handles basic HIPAA transactions such as eligibility, claims management, referrals and authorizations and provides opportunities to deliver value-based care. NaviNet Open also delivers an unprecedented level of rich detail enabling providers to raise efficiency and optimize the patient experience.

NaviNet Open can help you get ahead by radically updating what's obsolete in today's healthcare IT environment.

Enhance Your Portal

  • NaviNet Open let's you keep your existing portal while enhancing it to succeed in the dynamic world of healthcare post-reform.
  • Value-based care is changing the face of healthcare and necessitating technology to support the flow of critical information between health plans and providers. The change also means that multiple sources of clinical information must be accessed to deliver a complete profile of the patient, allowing the provider to impact outcomes from the point of care. NaviNet Open features a suite of value-based network applications designed to enable health plans and providers to keep up with the changing demands of healthcare.
  • Value-based applications can be added to your current portal environment, providing additional capabilities for succeeding with value-based healthcare.

The modular nature of NaviNet Open can help you succeed with new opportunities in value-based care by introducing new capabilities along with flexibility and extensibility.

Keep Your Technology Open

  • You shouldn't be locked in to a technology, your own or a vendor’s. NaviNet Open is a powerful platform for developing network-based applications. Rich API’s for accessing the platform’s capabilities, developer tools, robust provider data management and an event-based architecture round out a framework for developing value-based applications to meet the rapidly evolving needs of increased payer-provider collaboration.

Problems We're Solving

Limited Collaboration

Payers and Providers have historically had competing or different goals and needs. Accountable Care changes this and NaviNet Open is built entirely around solving issues with payer-provider collaboration.

Legacy Portals

Most legacy portals lack the technological capability to detect patient needs and alert providers. In a multi-payer portal environment, NaviNet Open gives providers the ability to deliver better healthcare all with one log-in.

Clinical Data Sharing Challenges

At the core of collaboration is sharing. There needs to be a uniform way to handle clinical and reimbursement information. With NaviNet Open, clinical and reimbursement data can now be exchanged in real time to provide smarter patient care.

Lack of Network Intelligence

Many legacy portals don't provide rich detail at the right time. NaviNet Open listens with background detection of patient needs, giving providers the immediate ability to act within their familiar workflows like checking Eligibility & Benefits, doing referrals or prior authorizations.

Value-based Care Challenges

Incentive programs are moving toward rewards based on value provided, not just how many patients were seen. Accountable Care promotes value-based care. With NaviNet Open payers and providers can now work toward shared goals with the highest intention of the patient in mind.

Increasing IT Demands

Most IT healthcare systems today are plagued by the change Accountable Care brings and the need to collaborate in new ways. They face expensive upgrades, proprietary systems, rigid data models, or are unable to interface with critical Third Party systems. NaviNet Open provides flexible, extensible technology allowing you to easily replace or enhance your existing provider portal.

Are you ready for Payer-Provider Collaboration?


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