NaviNet Open
Core administrative processing systems software
Health care software
Health care operations software
- Features
- Ease of use
- Ease of management
- Quality of support
- Affordability
- Market presence
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$75 per month
Free Trial unavailable
Free version
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What is NaviNet Open
NaviNet Open is a healthcare payer-provider connectivity and workflow platform used to exchange administrative and clinical information between health plans and provider organizations. It supports use cases such as eligibility and benefits verification, prior authorization, claims status, referrals, and secure messaging through a web portal and integrations. The product is positioned as an “open” connectivity layer that links multiple payer and provider systems rather than replacing core claims administration platforms. It is typically used by provider office staff, revenue cycle teams, and payer operations teams to reduce manual phone/fax workflows.
Broad payer-provider connectivity
The platform is designed to connect providers with multiple health plans through a single interface for common administrative transactions. This can reduce the need for staff to navigate separate payer portals for eligibility, authorizations, and claims status. It fits organizations that need a connectivity layer without changing their underlying claims or practice systems.
Administrative workflow support
NaviNet Open focuses on operational transactions that drive day-to-day payer-provider collaboration, including prior authorization and referral workflows. It helps standardize intake and status tracking compared with phone/fax processes. This operational focus aligns with organizations looking to streamline front-office and revenue cycle tasks rather than implement a full core administrative processing system.
Integration and interoperability orientation
The product is commonly implemented alongside existing payer cores and provider systems, acting as a routing and interaction layer. This approach can shorten time-to-value compared with replacing core claims platforms. It also supports use cases where multiple lines of business and disparate back-end systems must be accessed through a consistent user experience.
Not a core claims system
NaviNet Open is not positioned to replace a payer’s core administrative processing system for claims adjudication, product configuration, or premium billing. Organizations still need separate platforms for core processing and financial functions. Buyers evaluating end-to-end payer cores may find functional gaps outside portal and transaction workflows.
Value depends on network coverage
The utility of a connectivity portal depends on which payers and provider organizations are available in the network and which transactions are enabled for each relationship. Coverage and transaction depth can vary by market, line of business, and payer configuration. Some organizations may still need to maintain supplemental payer portals or manual processes for exceptions.
Implementation varies by payer setup
Capabilities such as prior authorization automation and real-time status updates often require payer-side configuration and integration with internal systems. As a result, provider experience can be inconsistent across different health plans using the platform. Buyers should validate transaction-specific workflows, response times, and data completeness for their key payer relationships.
Plan & Pricing
| Plan | Price | Key features & notes |
|---|---|---|
| Standard | Free | Monthly base price: Free. (Includes up to 250 transactions). Part of NaviNet AllPayer (accessible via NaviNet Open). |
| Basic | $75+ per month | Monthly base price includes up to 250 transactions. Further monthly E&B volume fees: 251–750 = +$85; Over 750 = +$180 and +$0.14 per transaction. Includes eligibility & benefits, basic workflows. |
| Premium | $100+ per month | Monthly base price includes up to 250 transactions. Further monthly E&B and CSI volume fees: 251–750 = +$80; Over 750 = +$175 and +$0.14 per transaction. Adds claim status inquiry workflows. |
| Ultimate | $200+ per month | Monthly base price includes up to 250 E&B & CSI transactions PLUS up to 250 claim submission transactions. Further monthly E&B/CSI fees: 251–750 = +$80; Over 750 = +$175 and +$0.14 per transaction. Claim submission transaction fees: Over 250 = +$0.40 per transaction. Includes full claims submission/management, enhanced scrubbing, multi-payer support. |
Notes: Pricing data taken from the official NantHealth / NaviNet AllPayer detailed pricing PDF (NaviNet AllPayer Pricing Overview & Detailed Pricing). All pricing is month-to-month and actual fees are based on transaction volume for the previous month. An interactive pricing calculator and storefront are provided on the official site. This pricing applies to the NaviNet AllPayer subscriptions (provider-facing subscriptions) which are accessible through the NaviNet Open platform.
Seller details
NaviNet, Inc. (an Optum company, UnitedHealth Group)
Boston, Massachusetts, US
1993
Subsidiary
https://www.navinet.net/
https://www.linkedin.com/company/navinet/
