NaviNet
Delivering Next-Generation Payer-Provider Collaboration Network Solutions

The morning traffic barely seems to affect Frank Ingari, who shares views with an industry thought leader on his phone while walking to work, “Healthcare reform is designed to encourage major players to share responsibility—insurers to take ownership of the quality of care associated with their insurance, and providers to take ownership of the costs associated with the best evidence-based treatment for their patients,” says Ingari. “In such a scenario, the organizations’ power to harness and make use of data will determine their survival,” he adds. “This calls for information-sharing in unprecedented ways to reduce redundancy, cut costs, coordinate care, and drive positive patient outcomes.” As the CEO of NaviNet, Ingari is determined to provide this needed “information sharing” through the company’s unique next-generation enterprise class network solution, which supports value-based reimbursement and clinical workflows.

Having been in the market for more than 15 years, NaviNet is a real-time healthcare communications network company focused on payer-provider collaboration. “We have close to 40 longterm health plan customers, and we serve 60 percent of the providers in the U.S.,” stated Ingari. The company’s best-in-class provider adoption practices are based on a unique combination of product design; extensive end-user research and proprietary promotion; and training and communications approaches.

The NaviNet Open Platform

The company’s flagship product, NaviNet Open, is a next-generation payerprovider communications solution that integrates reimbursement-related and clinical workflows. Unlike conventional payer-provider platform solutions built as extensions to clearinghouse technology, NaviNet Open offers a portal and set of customer-configurable value-based network applications hosted on a robust enterprise cloud software platform that enable payers and providers to innovate rapidly in response to the changing demands of healthcare reform.

The solution set is built to leverage standards for reimbursement-related and clinical workflow applications such as clinical document exchange, transition management, and advanced referrals and authorizations. It consists of a series of layers: a platform, a set of network services, a suite of reimbursement-related and clinical applications, and a set of tools that customers can use to configure and customize the system.

The NaviNet Open layered architecture provides the flexibility necessary to accommodate change and promote growth as health plans launch new businesses and products. “NaviNet’s next-generation payer-provider healthcare communications network connects Big Data informatics systems developed by payers, delivery systems, and software vendors to the heterogeneous provider community, enabling the sharing of critical real-time intelligence and rapid innovation for the quickly changing demands of healthcare reforms,” claims Ingari, a Cornell Grad.

NaviNet finds traction in a vast array of health plan market segments. For instance, in the last 12-month window, NaviNet released multiple new health plans for its current clients to support ACO, Medicaid, and Medicare regionally and community-focused lines of business. Prior to implementing NaviNet, it cost one major payer $16.00 per phone call when a doctor needed to check eligibility or obtain authorization. Post-NaviNet, the call was replaced with a self-service web transaction that cost $0.16. The company works closely with customers and future customers to understand market requirements both at the strategic and tactical levels. “We have the industry experience and are part of the thought leadership community in order to share best practices with our health plan partners to help them develop their longterm strategies. At NaviNet, we facilitate collaboration and cooperation across the healthcare ecosystem,” asserts Ingari.

NaviNet aims to continue to serve as a strategic partner to its health plan customers and deliver on time with the highestquality solutions. “We are developing a series of value-based network applications that map to the needs of payers as they negotiate and institute value-based contracts with provider organizations,” concludes Ingari.

The NaviNet Open Value-Based Network Applications map to the needs of payers as they negotiate and institute value-based contracts with provider organizations