NaviNet: A Robust Payer-Provider Collaboration Platform for Healthcare

In today’s healthcare environment, medical care expenses are sky-rocketing, which has in-turn influenced federal bodies to formulate well-defined reforms to control this spiraling cost. As a result, new reimbursement models and accountable care models are pushing hospitals and insurance firms to follow a strict collaborative approach for better healthcare outcomes. “The sole idea behind the reforms is to lower costs, and improve the quality and customer experiences in the healthcare domain. Hence, insurance companies and healthcare providers must function in a synchronized manner to deliver absolute value to customers,” says Frank Ingari, President and CEO, NaviNet. Headquartered in Boston, MA, NaviNet bridges the gap between payers and providers nationwide by delivering a rich set of software and services to facilitate the smooth flow of quality healthcare at lower costs.

NaviNet’s payer-provider collaboration platform, NaviNet Open, is a cloud-based solution that hosts rich industry-leading applications that combine administrative, clinical, and financial information within a highly intuitive multi-payer provider portal. Chuck Digate, Chief Commercial Officer and SVP of Sales, Marketing and Business Development
The portal enables provider offices to execute trans-actions including patient eligibility and benefits claim status inquiries, referrals, authorizations, and numerous other trans¬actions all under one roof. “Physicians and hospitals need to validate insurance eligibility checks on individuals to ascertain the type of medical treatment they are entitled for,” states Ingari. Through the NaviNet Open Multi-Payer Portal, a patient’s vital data can be acknowledged in real-time to provide effective medical care.

Authorizations and referrals of health services are also taken care of through the portal, which ensures that the treatment is carried out on time. “The NaviNet Open Multi-Payer Portal is a quick response system that allows both the clinicians and payers to work in a coordinated manner with greater efficiency,” says Chuck Digate, SVP and Chief Commercial Officer at NaviNet. Most recently, the company launched NaviNet Open Document Exchange, an application that allows payers and providers to exchange clinical and administrative information in real-time, including care gaps, high-risk patient lists, and coding re considerations for risk adjustment requirements. By embedding clinical intelligence within existing workflows, NaviNet Open Document Exchange enhances better collaboration and efficiency between payers and providers.

NaviNet’s superior solutions have served some of the major providers in the healthcare domain. The firm’s clientele includes many Blue Cross Blue Shield payers including Independent Blue Cross, Horizon Blue Cross Blue Shield of New Jersey, High mark, as well as consumer-focused newcomers, Oscar health Insurance, and many more. Digate touched upon a success story where they helped Tandigm Health, an organization that supports primary care physicians located near the Philadelphia region.
Frank Ingari, President and CEO

Functioning as a joint venture with an insurance company, the client required a solution to meet patients’ demands for referral care that provided guided decision support to high quality physicians. NaviNet joined hands with the client to design a solution that can solve this issue easily. “We deployed the solution and configured it accordingly with the help of our specialized team and initiated the operations for them,” shares Digate. Tandigm implemented the product across all of their service areas and witnessed drastic improvement in operations.

NaviNet takes pride in its collaborative healthcare portal that unites the payers and providers under one roof to carry out all the transactions. “Our widespread network allows both the payers and insurance organizations to gain access to vital information and perform all transactions instantly,” asserts Ingari.

Moving forward, the company intends to expand its horizon to serve a larger customer base. “We are now focused on multiple portal products to deliver a sophisticated network for our clients. We will also be working on new projects by partnering with major technology companies in the near future,” concludes Ingari.

Company
NaviNet

Headquarters
Boston, MA

Management
Chuck Digate, Chief Commercial Officer and SVP of Sales, Marketing and Business Development and Frank Ingari, President and CEO

Description
Helps payers and providers enhance care quality, lower costs, and improve population health management with NaviNet Open.