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NaviNet® Eligibility and Benefits Inquiry enhancement 

February 28, 2018    

Recently, the Eligibility and Benefits Inquiry transaction on the NaviNet web portal was updated to include a “Site of Service Applies” indicator. This new indicator is to alert providers that the member has a plan with a site-of-service benefit. Site-of-service benefits are available for members enrolled in an Affordable Care Act plan and commercial members in large groups (51+). The specific services to which the site-of-service differentials apply can vary.

Below is an example of what providers may see when accessing the Eligibility and Benefits Details screen on NaviNet.

Site-of-service benefit differentials allow members to save on out-of-pocket costs – in some cases hundreds of dollars – based on where they receive certain services. Services that have a site-of-service benefit include:

  • preventive colonoscopy
  • outpatient lab*
  • outpatient surgery
  • physical/occupational therapy*
  • routine/complex radiology*

The applicable cost-share information for these services can be found in the Benefits section.

We have updated the Eligibility and Benefits Inquiry Guide to include this new indicator, which can be found in the NaviNet Resources section. If you have additional questions on the Eligibility and Benefits Inquiry transaction, please call the eBusiness Hotline at 215-640-7410.

*Available under PPO options only.

NaviNet is a registered trademark of NaviNet, Inc., an independent company.

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