NaviNet for Providers
Submit, adjust, and track claims in one multi-payer workflow
Subscribe to NaviNet AllPayer and replace costly paper claims and phone-based follow-up with real-time electronic submission across 8,100+ payers.
Claim rework is quietly draining your operating budget
Industry data puts the cost of reworking a single denied claim between $25 and $117. With 20% of claims initially denied or delayed, the math adds up fast.
Traditional claims workflow
- Paper claims and attachments add cost and delay
- Clearinghouse per-provider fees eat into margins
- Phone-based follow-up for claim status
- Manual rework of denied claims with no single source of truth
- Separate systems for submission, adjustments, and attachments
A unified multi-payer claims workflow
- Real-time electronic submission across 8,100+ payers
- One subscription covers your whole office
- Multi-payer claims log with one-click actions
- In-workflow adjustments, attachments, and investigation
- Direct access to electronic remittance information
$2.6 billion of avoidable cost, industry-wide
The CAQH Index quantifies the cost difference between manual and electronic claims workflows. The gap is significant, and most of it is recoverable.
- $2.6B
Potential savings from fully automating medical claims management across the industry.1
- 5x
Manual claim status inquiries cost roughly 5x electronic, $18.18 vs $3.68 per transaction.1
- 20%
Share of claims initially denied or delayed. Rework costs range from $25 to $117 per claim.2
- $6.30 → $4.65
Cost to process a single claim attachment manually vs. electronically.1
A single path from entry to reimbursement
Everything the claims lifecycle needs, in one place
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Claim Submission
Submit professional claims using simple real-time data entry, no practice management or EHR system required. Powerful enough for professional billers, easy enough for solo practitioners.
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Claim Adjustments
Edit and resubmit claims sent to health plans during pre- or post-adjudication, regardless of the original submission source.
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Claim Attachments
Upload and attach electronic documents directly in support of the claims adjudication process, no separate fax or mail step.
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Claim Investigation
A direct communication channel between provider and health plan to resolve questions about how a claim is being processed.
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Multi-payer Claims Log
A central view of every claim submitted or adjusted through NaviNet. One click to copy, adjust, attach, check status, or resubmit.
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Batch & real-time
Submit and adjudicate claims in batch or real time, whichever fits the way your office already works.
NaviNet Claim Submission vs. traditional clearinghouses
| Capability | Typical Clearinghouse | NaviNet Claim Submission |
|---|---|---|
| Per-provider submission fees | Yes, charged per biller | No, one office subscription |
| Real-time claim status inquiry | Limited, often paid add-on | Included for 660+ plans |
| Multi-payer claims log | Varies by vendor | Single unified log |
| In-workflow adjustments | Often requires resubmission | Pre- and post-adjudication |
| Electronic attachments | Separate enrollment per payer | Built-in across payers |
| PMS/EHR required | Usually required | No, works standalone |
What a unified claims workflow unlocks
- Reduce costs by replacing paper claims and cutting clearinghouse charges
- Direct electronic transactions between providers and health plans
- Less reliance on plan-subsidized billing software
- Accommodates complex claim exceptions for every practice size
- Works for large provider groups, solo practitioners, and amateur billers
- Supports edge cases like transportation companies and non-traditional billers
- One-click resubmission from the claims log
- Direct access to electronic remittance information
Common questions about NaviNet Claim Submission
Do I need a practice management system to use NaviNet Claim Submission?
No. NaviNet Claim Submission works standalone, direct, real-time data entry through the portal. That’s a deliberate design choice: it means solo practitioners, transportation companies, and non-traditional billers can submit claims without the overhead of a full PMS. If you do have a PMS, NaviNet complements it rather than replacing it.
How many health plans can I submit claims to?
With a NaviNet AllPayer Ultimate subscription, you can submit professional and institutional claims to 8,100+ organizations, including commercial and government health plans, ASO groups, and third-party administrators.
What’s the cost difference versus a clearinghouse?
Most clearinghouses charge per-provider fees to submit claims. NaviNet doesn’t, one AllPayer Ultimate subscription covers your entire office for claim submission. You keep more of what you earn, especially at higher volumes. Use our interactive pricing calculator to see how the numbers compare.
Can I adjust a claim after it’s been submitted?
Yes. NaviNet supports claim adjustments during both pre- and post-adjudication, regardless of the original submission source. You can also attach supporting documentation, investigate status, and resubmit, all from the same claims log.
What about electronic remittance (ERA)?
Direct access to electronic remittance information is included in the AllPayer Ultimate subscription. No separate ERA enrollment per payer required for supported plans.