NaviNet^®

Phone calls, faxes, and re-keyed forms. The transactions that dominate a provider office's contact with health plans move to structured digital workflows that return answers in near real time instead of on a callback. That means verifying eligibility, checking claim status, submitting an authorization, making a referral, and exchanging documents.

A manual claim status inquiry costs roughly $15.68 to process; the electronic equivalent costs about $2.07. Moving 10,000 transactions from manual to electronic saves in the region of $30,000. Industry-wide, eligibility automation alone represents an estimated $12.8B annual savings opportunity.

Source: CAQH Index (now the DataSpring Index), which reports annually on administrative transaction volume, cost, and automation rates across US healthcare. (opens in a new tab)

Standard access is provided through the health plans, not billed to the practice. NaviNet AllPayer^® is a separate provider subscription that extends reach to thousands of health plans, including payers, ASO groups, and third-party administrators, through the same single login.

A single-plan portal solves the problem for one plan and adds another login for every office in its network. NaviNet^® is the portal offices are already in for their other plans, which is why adoption is materially higher. Electronic prior authorization runs about 40% above the industry standard adoption rate.

Yes. That is the core of the model. Plans deploy a branded Plan Central workspace and configure workflows that match their own business rules, then choose which transaction apps to enable. Providers see a consistent interface; each plan gets its own logic behind it.

NaviNet^® is HIPAA compliant and HITRUST certified, with 25+ years of platform delivery and zero system outages. Security documentation is available under NDA during evaluation.