NaviNet for Providers
Verify eligibility in seconds, not phone calls
A NaviNet AllPayer subscription includes real-time membership verification, insurance coverage, and benefit details for 1,270+ health plans, built into the NaviNet workflow your staff already uses.
Eligibility checks shouldn’t eat your day
Without a real-time E&B workflow
- Staff spend hours each week on hold with payer call centers
- Coverage details captured inconsistently, plan to plan
- No visibility into care gaps or coding considerations at intake
- Every verification is re-work if data changes mid-cycle
A real-time, multi-payer eligibility workflow
- Instant, multi-payer verification from a single login
- Consistent interface across every plan your office touches
- Care gaps and patient summaries surface at the point of care
- Always-current data via real-time EDI gateway
From patient check-in to coverage confirmation in three steps
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1
Enter member info
Quick lookup by member ID, name, or date of birth across 1,270+ health plans.
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2
Real-time verification
NaviNet pings the payer’s system and returns live eligibility and coverage detail.
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3
Review detailed benefits
Copays, deductibles, and coordination of benefits, all in one view.
NaviNet is my favorite way to verify eligibility. It’s easy to read for beginners and has useful information.
NaviNet user since 2015
What a modern E&B workflow unlocks
- Immediate, accurate member eligibility and benefits information
- Dramatic reduction in inbound phone calls to health plans
- Higher staff productivity and lower per-transaction costs
- Better patient and condition-specific guidance at the point of care
- Consistent experience across every plan your office touches
- Faster patient check-in with accurate copay information
- Reduced claim denials caused by eligibility errors
Common questions about NaviNet E&B
How does NaviNet Eligibility & Benefits differ from a standard 270/271 check?
A standard 270/271 transaction gives you the bare-minimum eligibility response. NaviNet Eligibility & Benefits extends that with a consistent multi-payer UI and the ability to surface payload data that doesn’t fit the 271 format, such as care gap alerts, coding considerations, and patient summaries.
How many health plans can I verify eligibility for?
With a NaviNet AllPayer subscription, you get real-time eligibility and benefits verification across 1,270+ health plans, including commercial, Medicaid, and Medicare. Plan-sponsored workflows are available free on the NaviNet Standard account for any plans that partner with us directly.
What does "real-time" mean in practice?
NaviNet uses a real-time EDI gateway web service compliant with CAQH/CORE operating rules. In practice, verification responses return in seconds, not minutes, fast enough to happen while the patient is still at the front desk.
Do I need to integrate this with my practice management system?
No. NaviNet is a standalone portal that works out of the box. If you want to integrate it into your PMS or EHR workflow, that’s supported but not required. Many offices use it as a web-based overlay on top of whatever systems they already have.
Is patient data secure?
Yes. NaviNet is HITRUST certified and NCQA accredited, and all transactions are encrypted end-to-end. NantHealth maintains the same security posture expected by the largest commercial payers in the country.