NaviNet Health Plan Solutions
Back to solutions for health plansBenefits Administration
Give your providers secure, real-time access to the most current member eligibility and benefit information. Our solutions translate and communicate complex benefit information into a presentation that's easy to understand and use, resulting in fewer calls to your call center.
Learn more- Eligibility & Benefits Inquiry
- Prescription Benefits Inquiry
- Capitation Roster
- Card Swipe
Claim Management
Reduce your claim administration costs by enabling your providers to become more self-sufficient. Our solutions help your providers manage all aspects of the claim life cycle online, from submission to adjudication.
Learn more- Professional & Institutional Claim Submission
- Claim Status Inquiry
- Claim Investigation
- Claim Appeal/Adjustment
- Real-Time Claim Adjudication
Payment Management with NaviNet Health Plan Solutions
Streamline your ability to securely manage and deliver timely payments and notifications to your provider network for greater efficiency.
Learn more- Electronic Remittance Advice
- EFT Enrollment & Maintenance
- Patient Liability Estimator
- Payment Processing
- Patient Billing
Authorization & Care Management
Reduce your utilization review and management costs by allowing providers to serve themselves. Our solutions allow providers to manage authorization requests online, eliminating costly clinical phone calls.
Learn more- Referral Status & Precertification Inquiry
- Referral & Precertification Submission
- Real-Time Referral & Precertification Adjudication
- Referral/ Authorization Tracking Management
- Discharge Plan & Treatment Plan Submission
Clinical Messaging
Distribute timely clinical content to your providers to enhance the quality and efficiency of member care. Clinical Messaging is seamlessly inserted into your providers' existing office workflow.
Learn more- Care Alerts
- Clinical Reports
- Message Inbox
Directory & Code Library
Make it quick and easy for your providers to find other providers in your network and to locate the diagnosis and procedure codes needed to request authorizations or payment.
Learn more- Network Provider & Facility Search
- Diagnosis Code Inquiry
- Procedure Code Inquiry
Policy & Guidelines Reference
Offer your providers quick and easy access to the information they need to conduct business with your organization.
Learn more- Clinical Guidelines
- Formulary Lookup
- Medical Policy Inquiry
- Precertification Requirements
Health Record Exchange
Allow your providers and members to exchange health information securely—and ensure that providers have a more complete view of a member's health history.
Learn more- Personal Health Records (PHR)
- Sponsored Health Records (SHR)
Member/ Provider Communications
Give your providers and members a secure channel for requesting, and responding to requests for, clinical information and services.
Learn more- Personal Health Records (PHR)
- Appointments
- Billing Inquiries
- Referrals & Authorizations
- Clinical Results
- Online Visits
