NaviNet

What is NaviNet?

NaviNet is an easy-to-use, free, web-based platform that links providers to Keystone First. Through NaviNet, you can access and submit:

• Real-time clinical Healthcare Effectiveness Data and Information Set (HEDIS) alerts
• Eligibility information
• Claims information and updates
• Benefits information
• Drug authorizations
• Prior authorizations

NaviNet helps speed up the provider-health plan connection and can often replace paper transactions. 

Already a NaviNet User?

• Log on to NaviNet
• Don't see Keystone First Plan Central? Register for Keystone First

Not a NaviNet user?

• Learn more about this Web-based solutio linking providers with health plans.

NaviNet Features & Tools

• NaviNet Provider Data Info (PDIF) User Guide (PDF)
• NaviNet Medical Authorizations Participant Guide (PDF)
• NaviNet Basics
• NaviNet Enhancements Training Guide (PDF)
• NaviNet Medical Authorizations FAQ (PDF)
• Care Gaps
• Condition Optimization Program (COP)

Integrated Care Plan (ICP) Sharing in NaviNet

• ICP NaviNet Assessment Instructions (PDF)

Claim Inquiry Submission Instructions

• Claims Investigation Guide (PDF)

Care Gaps

• Provider Guide: Care Gaps Response Form (PDF)
• Care Gap Changes to Align with HEDIS® Measures (PDF)

Admissions and Discharge Alert (ADT) Guide

• NantHealth: Document Exchange ADT Alerts (PDF)