In recent months, we have communicated information about several new
transactions being introduced to
Independence providers on the NaviNet web portal, including Eligibility and
Benefits Inquiry, Claims Dashboard, and
Document Exchange. New user guides are now available for these transactions,
and we strongly encourage you to
review them to become more familiar with the updates.
Eligibility and Benefits Inquiry
In July, we introduced our new Eligibility and Benefits Inquiry transaction
to a select number of provider offices. Starting on August 3,
2016, all remaining NaviNet-enabled participating providers will be
given access to this new
transaction.
The member search criteria will be modified, and the presentation of the
eligibility and benefits information will
change. The updated transaction will continue to provide you with access to
real-time, detailed eligibility and benefits
information for Independence members. You will be able to view information
about a member?s demographics,
insurance, and cost-sharing (e.g., copayment, deductible, and coinsurance). In
addition, the Eligibility and Benefits
Details screen will offer a list of benefit categories to view and will
continue to include links to the member?s capitated
site information (where applicable), ID card, and product-wide provisions
associated with the member?s benefit plan.
Please note the following about the new Eligibility and Benefits Inquiry
transaction:
- FEP members. The new transaction will not return
information for Federal Employee Program (FEP) members.
You will need to obtain eligibility and benefits information for FEP members
through the Eligibility and Benefits
Inquiry transaction in the BlueExchange® Out of Area Workflows
menu option.
- Dates of service. The new transaction will eventually
allow you to search for a member?s eligibility and benefits record up to two
years in the past from the current date. However, when the new transaction is
first released,
you will only be able to search retroactively for dates of service on or after
July 1, 2015. Eligibility and benefits
information will not be available through NaviNet for
dates of service prior to July 1, 2015.
Claims Dashboard
We recently introduced the new Claims Dashboard transaction, which allows
you to view your Accounts Receivable
in a more comprehensive manner. Claims Dashboard provides you with access to
view both pended and finalized
claims.
Note: The data presented within the transaction is provided for
general informational purposes. In addition, there is a
lag time between finalized and pended claims data updates.
Document Exchange
Later this month, Document Exchange will be introduced to Independence
providers. This new feature will allow us to
share more information electronically with our provider network.
When Document Exchange is first released, your designated NaviNet Security
Officer will control which end users,
including himself or herself, associated with your NaviNet office will be given
access to the following five unique
Practice Document Categories:
- Billing/Financial Report
- Patient Roster Report
- Patient Transition Report
- Pharmacy Report
- Program Enrollment Report
Once an end user is granted permission to access a specific Practice
Document Category, that individual will be
able to view and download any documents associated with that category. For
example, if a NaviNet Security Officer
grants permission to an associate to access the Billing/Financial Reports
category, all reports made available by
Independence under that category will be available to the associate to view or
download.
It is important that your designated NaviNet Security Officer manages
permissions appropriately for each document
category to ensure reports are accessed in a manner that is compliant with
role-based access requirements of the
Health Insurance Portability and Accountability Act (HIPAA).
Note: Third-party vendors that have access to NaviNet
will not have the ability to access Document
Exchange.
Initial report
The first report that will be made available under Document Exchange will be
the High Risk Hospitalization Predictor
report from August 2016 (not February 2016, which was previously communicated).
This report will be made available
to targeted primary care physician practices and, based on a predictive model,
identifies members treated who are at
high risk of acute hospitalization in the next six months and who have one or
more of the following chronic conditions:
- chronic obstructive pulmonary disease (COPD)
- congestive heart failure (CHF)
- coronary artery disease (CAD)
- diabetes
If you have questions or suggestions that relate to the High Risk
Hospitalization Predictor report, please contact your
network medical director.
For more information
You can download the recently published user guides for these new
transactions in the NaviNet Resources section
of our Provider News Center. If you have any questions about any NaviNet
transactions,
please call the eBusiness Hotline at 215-640-7410.
NaviNet is a registered trademark of NaviNet, Inc., an
independent company.