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As previously communicated, Document Exchange will soon be introduced to
providers on the NaviNet web portal.
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 end users are granted permission to access a specific Practice Document
Category, they 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 for your NaviNet Security Officer to manage 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 High Risk Hospitalization Predictor report from February 2016
will be the first report made available for targeted primary care physician
practices under Document Exchange. Based on a predictive model, this report
identifies members you have 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
A new user guide for Document Exchange is now available in the NaviNet Resources section of
our Provider News Center. It provides detailed instructions on how to use this
new feature.
If you have any questions about Document Exchange, call the eBusiness
Hotline at 215-640-7410.
Reminder: Provider self-service
requirements
All participating providers (including third-party administrators supporting
the organization) are required to have access to NaviNet. In addition, all
participating providers are required to use NaviNet for specific activities,
including:
- Member Eligibility.The Eligibility and Benefits Inquiry transaction
provides you with detailed information relating to our members'
eligibility.
- Claim Status Inquiry. This transaction allows you to view the
progress of your accepted claim submission. You can view claims with service
dates up to 18 months in the past. The claim detail includes specific
information, such as check date, service codes, paid amount, and member
responsibility.
- Claim Investigation. Providers who call Customer Service to question
claim payment or to request a claim adjustment must submit those requests
through the Claim Investigation transaction. A link to Claim Investigation can
be found when searching for a specific claim through Claim Status Inquiry. If,
however, you are experiencing an issue that affects a significant number of
claims, we recommend that you contact your Network Coordinator for assistance
rather than submit an adjustment request through NaviNet.
If you have not yet registered for NaviNet, you can request access by going to
the
NaviNet website.
NaviNet is a registered trademark of NaviNet, Inc., an
independent company.
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