Connect With Your Entire Provider Network
As an organization that prioritizes value-based care, your ability to communicate across a flexible, extensible platform is critical. NaviNet® Open is one of America’s leading payer-provider collaboration platforms, facilitating provider engagement and generating trustworthy, actionable data throughout the continuum of care delivery.
A secure multi-payer platform, NaviNet Open enhances communication, boosts operating efficiency, cuts costs, and improves provider satisfaction. It lets payers and providers exchange vital administrative, financial, and clinical information in real-time.
Safe, Secure, Streamlined
NaviNet Open is HITRUST certified, having met key regulations and industry-defined requirements. It is appropriately managing risk regarding third-party privacy, security and compliance.
NaviNet Open Solutions
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
Transmits administrative, financial, and clinical information in real-time, streamlining communication among health plans and providers—including fee schedules, risk adjustment information, quality measurement data, and performance reports.
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.