The NaviNet Open Eligibility and Benefits workflow lets you find and view patient eligibility and benefit details quickly and easily.
Accessing Eligibility and Benefits
Access Eligibility and Benefits under Workflows for This Plan on the Plan Central screen.
Searching for a Patient
On the Patient Search screen, you can search for a patient by:
- member ID and date of birth, or
- last name, first name (optional), and date of birth
The default date of service is the current date, but you can choose a different date up to two years in the past or 30 days in the future.
Viewing Eligibility and Benefits Details
The Eligibility and Benefits Details screen presents patient and coverage details. Patient eligibility is highlighted on a color-coded eligibility status bar. For the selected patient, date of service, and benefit type, you can quickly view detailed benefits including copays, coinsurance, deductibles, authorization requirements, and more.
To view more details, such as HMO code and network ID, click Additional Details.
By default, this screen shows you information for the Health Benefit Plan Coverage benefit type, but you can select or search for a different benefit type in the Benefits menu.
If you have a preferred benefit type for this health plan, select it in the Benefits menu and then click Set as Default Benefit View.