The NaviNet Claim Administration Module enables health plans to comprehensively address the high cost of manual claims administration, enabling health plans to realize significant administrative cost savings by moving these processes from the telephone to a Web-based solution. Providers take advantage of the NaviNet Claim Administration Module to, on a self-service basis, participate in the administration, including online claim pre-processing and correction, of claim workflows to resolve claim payment issues, without relying on manual intervention at the health plan level.

Functional Capabilities:

• Blue Exchange Claim Status Inquiry
• Claim Investigation Status Inquiry
• Claim Adjustment Request
• Claim Status Inquiry
• Claim Adjustment Status Inquiry
• Claim Status Payment Detail
• Claim Aging Report
• Electronic Remittance Advice
• Claim Appeal
• Request For Additional Information Action Item
• Claim Investigation Request

Health Plan Success:

• Uses the NaviMedix Claim Administration Module to enable pre-processing of claims transmitted by participating providers, greatly reducing claim denials and intervention for a variety of issues and significantly accelerating the reimbursement cycle.
• Cost reduction of more than 40% in provider call center with the shifting of claims related inquiries from expensive manual channels to NaviNet.
• Reduced cost of processing inquiries from providers regarding claim status by more than 50%.

Provider Success:

• Orthopedic practice has seen a significant increase in revenue by automating the claims investigation process via NaviNet.
• Claims processing and reimbursement outsourcing company reports a savings of more than 15 minutes per each claim status inquiry handled via NaviNet, translating into a savings of more than 65 hours each month.
• Women's clinic uses NaviNet to reduce the amount of time it takes to verify claim status with health plan by several hours each day.