NaviNet®

NaviNet reduces time and costs associated with daily health care administration.

Independence Blue Cross (IBC) offers network providers a way to simplify health care administration through our NaviNet web portal. NaviNet gives providers fast, secure, HIPAA-compliant access to provider and member information, and enables real-time transactions. Best of all, NaviNet is free and requires no additional software.

What administrative tasks can I perform using NaviNet?

Inquiries:

  • confirm eligibility and benefits information, including plan type, coverage dates, copayments, coordination of benefits, preexisting condition clause information, PCP, and PCP-capitated sites (when applicable), for local and out-of-area Blue Plan members;
  • retrieve up to two years of historic claims data (including paid, denied, and in-process/pended claims);
  • view inpatient, outpatient, concurrent or post-discharge days review, and ancillary authorizations (and when applicable, edit admission or service dates for approved authorizations);
  • retrieve electronic referrals within 365 days of the referral date;
  • perform code-to-English/English-to-code procedure and diagnosis code inquiries;
  • view drug formularies and medical policies;
  • perform provider network searches.

Submissions:

  • submit adjustments for finalized claims;
  • submit application for Electronic Fund Transfer (EFT) for claim payments;
  • submit registration for online Statement of Remittance (SOR);
  • submit referrals to the plan and to NaviNet-enabled specialists and facilities electronically (use the optional NaviNet auto-fax feature to fax referrals to specialists and facilities, even to those who are not registered with NaviNet);
  • submit encounters to report covered services performed by PCPs that are part of the PCP capitation arrangement with the plan (for use by PCPs only);
  • submit drug prior authorization requests for determination and response within 48 hours;
  • submit authorization requests for inpatient and outpatient procedures, sleep studies, speech therapy, home health, home infusion care, and DME (including requests for extensions to already approved authorizations, the addition of new services to existing approved authorizations, and new services not associated with existing approved authorizations);
  • submit notification of emergency admissions (for use by hospitals only);
  • submit changes to your practice information, HMO capitated specialists, and additions of newly credentialed or participating providers and/or additions of hospital affiliations.

What are the requirements for NaviNet Portal registration?

You will need:

  • HMO or PPO network participation;
  • computer access;
  • Microsoft Operating System (minimum requirement: Windows 98);
  • Internet access (minimum requirement: Internet Explorer 5.01, Service Pack 2).

How to get NaviNet for your office:

NaviNet Portal registration or questions:

eBusiness Provider Hotline
215-640-7410

Technical assistance for existing NaviNet users:

NaviNet, Inc.
1-888-482-8057

You may also submit an online inquiry form.

NaviNet® is a registered trademark of NaviNet, Inc.

An affiliate of IBC holds a minority ownership interest in NaviNet, Inc., an independent company.