NantHealth NaviNet^® Open

NaviNet Open Eligibility and Benefits

Delivers membership verification and insurance coverage information to provider offices in real-time. Tailored to your organization’s business needs, NaviNet Open Eligibility and Benefits displays copayment, deductible, and benefit information, and is designed to easily extend to display more detailed information.

NaviNet Open Claim Status Inquiry (CSI)

Gives provider offices access to detailed financial and claim status information in real-time, eliminating the need to call a payer organization directly. CSI aligns health plan and provider interests by automating the delivery not just of claim receipt confirmation and adjudication status, but also important payment details.

NaviNet Open Claims Management

A collection of tools for providers and payers to manage reimbursement:

• Professional Claim Submission
• Claim Corrections and Adjustments
• Claim Attachments
• Claim Investigation
• Claim Appeals

NaviNet Open Authorizations

Allows providers to submit medical prior-authorization requests and access the most up-to-date authorization information from health plans—such as status updates, approvals or denials, and requests for additional information. It optimizes the authorization process, making it easy for health plans to configure fields and add additional business logic and integrate with third-party applications, as well as add-on workflow capabilities to better support necessity requirements.

NaviNet Open Referrals

Allows provider offices to submit and access referrals in real-time, guiding patients to the best specialist at the most affordable cost, and equipping staff with more information to navigate complex sub-networks while health plans optimize in-network or value-based referrals.

NaviNet Open Document Exchange

Streamline health plan-provider communication with real-time transmission of administrative, financial, and clinical data (fee schedules, risk adjustment, quality measures, performance reports). A self-service application empowers payer business users to collaborate directly with chosen providers, creating a comprehensive solution for efficient healthcare information exchange. Learn more.

Align Payer, Provider, and Patient Incentives

With NaviNet Open, both payers and providers benefit from increased operational efficiency, streamlined communication, and significant savings. Reduce manual processes across your organization through decreased administrative complexity—and increased transparency, leading to timely, higher quality, more cost-effective care that directly benefits patients.