Claim Status Enhancements

Health Plans: 

  • Blue Cross and Blue Shield of Nebraska,
  • NaviNet Open

Workflow: 

  • Claim Status

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.

ClaimsSearchCallouts

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. 

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Related Topics

Claim Status User Guide

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