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You will begin to see additional changes to the NaviNet web portal as we
continue to transition our claims processing to
the new operating platform.
Reminder: When conducting transactions from IBC NaviNet Plan
Central, search results will include information only for
members covered under IBC plans.
New transactions
The following are new transactions that will be introduced:
- EOB and Remittance Inquiry. This new transaction will be
available in December to all participating providers who are
NaviNet-enabled (i.e., no enrollment for the transaction is necessary). This
transaction will provide claims payment
information for claims processed on the new platform (i.e., for members who
have been migrated to the new platform).
The statements will include A/R detail, when appropriate. Through this
transaction, providers will also be able to
download and/or print remittances.
Note: Providers currently enrolled for the Online Statement of
Remittance (SOR) will continue to have access to
remittance data for claims processed on the current IBC platform
(i.e., for members who have not yet been migrated to
the new platform).
- Network Provider Inquiry/Network Facility
Inquiry. These two new transactions will be available later this month
to
help you locate physicians or facilities affiliated with a specific IBC network
(e.g., HMO/POS, PPO).
Changes to existing transactions
The following are changes to existing transactions that will be implemented
this month:
- BlueExchange® Out of Area — Ref/Auth
Submission. This transaction allows you to submit referral and
authorization
requests for out-of-area BlueCard® members. The search criteria
and data display will be enhanced to assist providers
when treating out-of-area members.
- Diagnosis Code Inquiry/Procedure Code Inquiry. These two
transactions allow you to search for diagnosis codes or
procedure codes maintained by the National Center for Health Statistics (NCHS).
The search criteria and data display
will be enhanced to better assist you with these inquiries.
Note: We previously communicated that the Clear Claim
ConnectionTM transaction would be disabled; however, a
decision has been made to keep this transaction. Therefore, no changes are
being made to the Clear Claim Connection
transaction at this time.
For more information
To help you better understand these changes, we will make available new user
guides that will describe the
transactions in greater detail. We encourage you to review these new guides on
our Business
Transformation
site. Announcements will be made on IBC NaviNet Plan Central and on
our Provider News Center once the new
guides are posted.
If you have any questions regarding the NaviNet transactions changes, please
call the eBusiness hotline at
215-640-7410.
NaviNet® is a registered trademark of
NaviNet, Inc., an independent company.
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