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New NaviNet® transaction for EOB and Remittance Inquiry and other changes coming soon

November 1, 2013

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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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