The NaviNet Open Claim Status workflow provides easy access to the status and details of a patient's claim.
Accessing Claim Status
Claim Status is available under Workflows For This Plan on the Plan Central screen.
Claims Search Screen
- The Claims Search screen can now be customized by the health plan.
- The standard search screen is shown below, but you might see other fields depending on the health plan’s configurations.
- All fields are required unless marked “Optional.”
- Clicking the Billing Entity field produces a list of available billing entities from which to select.
Claim Details Screen
The Claim Details screen has been updated and includes the following enhancements:
- The Print link allows you to print claim status information directly from the Claim Details screen.
- The claim status appears in a colored status bar so the claim can be easily identified as finalized (green), denied (red), or pended (gray). The status effective date appears only if the health plan confirms it.
- The Provider(s) box displays details for the servicing provider and the billing entity (facility provider).
- The claim summary section displays the two most important dollar amounts:
- Total Charge: the amount charged by the provider
- Paid by: the amount paid by the health plan
- If configured by the health plan, the Payment Number link in the claim summary section provides easy access to remittance advice.
- Additional details, including the patient account number, bill type, voucher identifier, and clearinghouse trace number can be found in the Additional Details box.
- Member insurance information can be viewed in the Patient’s Insurance box, which may include a View Eligibility and Benefits link for access to the member's Eligibility & Benefits Details screen if configured by the health plan.
- The Service Line Details section now provides additional individual claim line information, including revenue codes and status descriptions.