NaviNet HealthCare Communication Network – Transactional Portal Information Exchange

NaviNet in Massachusetts has worked for over 10 years in setting up transactional communication between providers, hospitals and insurance companies. You can read below where I included a few lines from the interview in Xconomy. Insurers are able to connect and share information through the portal instead of having to use mail.

One of the services offered allows physician offices to collect payments at the point of service and set up payment plans with patients and they are working on a plan to enable the selling of bad debt. The company looks at PHRs, like Google Health and HealthVault as partners too, with the ability to perhaps share information down the road. BD

NaviNet helps doctors’ offices instantly access patients’ insurance information, such as their benefits eligibility and claims status, over the Web. So far it’s connected 770,000 doctors and other healthcare providers to the network, covering about 40 percent of the total market, according to Waugh. Big health insurers like Blue Cross Blue Shield, Aetna, and UnitedHealthcare are attracted to and use NaviNet’s services because they save money by accessing sharing information via the company’s Web portal rather than through costlier call centers, Waugh says. NaviNet makes the bulk of its money, he says, on transaction fees that insurers pay the firm to connect with doctors.

X: What’s been NaviNet’s experience in working with the federal government?

BW: Providers have told us that it’s taking them a long, long time for them to get paid by the federal government. We heard numbers of two months to up to six months to get reimbursements from the federal government. And 44 percent of all their claims were sent back to doctors’ offices, and they would have to redo the entire form again. So we automated that process and came out with our own direct network connection to CMS [the Centers for Medicare & Medicaid Services at the Department of Health and Human Services] with what we call NaviNet Medicare Eligibility, which enables an administrator to fill out a reimbursement form online in real-time and send it to CMS. We’re seeing doctors get reimbursed from the agency in an average of 28 days today.

X: How does NaviNet plan to compete with IT giants like Google and Microsoft, both of which are moving aggressively into the healthcare market?

BW: They are trying to come up with an application that works with the patient community. Our network is a provider-payer network. We are beginning to do such things as clinical alerts to send critical information in real-time to both patients and providers. But what Google and Microsoft are doing is working directly with patient records and the permission statuses to transport those records to providers. We see Microsoft and Google as potential partners that could utilize our network, and I think everyone at my company is cheering on those firms. With the name recognition and capabilities they have, they could make a real difference.