The NaviNet Authorization and Referral Management Module enables the automation of both simple and complex medical care authorizations and referral processing, allowing clinical staff at the health plan to concentrate on initiatives that impact cost and quality of healthcare for members. Healthcare providers take advantage of the NaviNet Authorization and Referral Management Module to eliminate telephone interaction with health plans and significantly reduce paperwork and processing time.

Functional Capabilities:

• Request for Referral Action Item
• Automated Referral Adjudication
• Pre-Certification Submission
• Drug Prior Authorization Submission
• Referral Status Inquiry
• Formulary Override/Appeal Submission
• Referral Submission
• OB/GYN Referral Submission
• Request for Additional Information
• Plan Authorization Management and Tracking
• Service Authorization Submission
• Pre-Certification Status Inquiry

Health Plan Success:

• Moved referral process from a proprietary system and other manual methods, such as paper, to NaviNet at a savings of more than $1 per referral. Front-line telephone staff process an authorization via NaviNet 53% faster than via the telephone.
• Increased the number of referrals processed electronically from 1% pre-NaviNet to more than 70% today.
• Significant cost savings associated with administering referrals while dramatically increasing provider satisfaction with the plan.
• Cost reduction of nearly 40% for processing referrals since the implementation of NaviNet.

Provider Success:

• Pediatrics group has converted referral processing activities from a cumbersome manual process to NaviNet, resulting in timesavings of more than 10 hours each week.
• Orthopedic group has reduced the amount of time spent processing referrals and authorizations by 95% with NaviNet.
• Ob/Gyn practice has decreased the amount of time to process a surgical pre-certification from 20 minutes to less than two minutes via NaviNet.