The NaviNet Benefit Administration Module enables health plans to transform member eligibility and benefits processing from a manual, telephone-intensive environment to a Web-based solution that addresses today's benefit administration needs while concentrating on the growing complexity of new health plan product offerings. The NaviNet Benefit Administration Module enables providers to efficiently process patient eligibility and benefits information, including status, co-pay and other patient financial responsibility information and patient care information without reliance on telephone and other manual processing channels.

Functional Capabilities:

• Blue Exchange Eligibility Inquiry
• Eligibility Inquiry
• Coordination of Benefits
• Prescription Benefits Inquiry
• Detail Benefits Inquiry

Health Plan Success:

• Reduced number of member eligibility inquiries handled by provider call center unit by more than 40%.
• Realized cost savings of more than 50% by moving member eligibility from EDI and telephone to NaviNet.
• Eligibility inquiries handled by phone unit for providers who are NaviNet-enabled decreased by more than 50%.
• Leading national plan and its provider network have reported a 50% reduction in the amount of time spent resolving eligibility issues with NaviNet.

Provider Success:

• Integrated medical group realized timesavings of 85% by moving patient eligibility and benefits processing to NaviNet.
• Children's hospital reported savings of more than 30 hours each week by processing patient eligibility and benefits via NaviNet versus the telephone.
• General practice group saves more than 30 hours each week by automating patient eligibility and benefits via NaviNet.