NaviNet
NaviNet is a NantHealth subsidiary that operates a HIPAA-compliant web portal connecting U.S. healthcare providers with multiple health plans for eligibility, claims, document exchange, and prior authorization workflows, monetized via tiered AllPayer subscriptions and transaction fees.
- Company typePrivate
- Founded1998
- HeadquartersBoston, United States
- Headcount101–250
- GTM typeB2B
- OfferingSoftware
What NaviNet does
NaviNet, Inc. is a U.S. healthcare technology company that operates a web-based SaaS portal enabling secure, HIPAA-compliant electronic exchange of administrative health information between healthcare providers and health plans. Founded in 1998 and headquartered in Boston, Massachusetts, NaviNet is a wholly-owned subsidiary of NantHealth and serves as the payer-provider connectivity layer inside NantHealth's broader healthcare technology portfolio. The platform supports eligibility verification, claims status inquiries, document exchange, and prior authorization submission, with a designated Security Officer model governing office-level access control. Beyond the free core portal, NaviNet monetizes through tiered AllPayer subscriptions (Basic, Premium, Ultimate) and transaction-based fees, while embedding CoverMyMeds-powered drug prior authorization workflows as an add-on service under supplemental terms of service.
The underlying platform is built around multi-payer interoperability: providers register via Federal Tax ID matching against health plan records, after which they can access workflows from multiple contracted health plans through a single interface. NaviNet maintains Business Associate Agreements with each health plan subscriber in compliance with 45 CFR §164.504(e), and the platform is restricted to U.S. operations. The company has historically pursued inorganic expansion through acquisitions of Topline Solutions (2008) and Prematics (2010), and maintains a B2B2C distribution model in which health plans act as channel partners that distribute NaviNet to their contracted provider networks. Operations are governed by Massachusetts law and the NaviNet Use Agreement (last updated January 2025), with no public API, mobile application, or disclosed AI/ML capability present in the current product.
NaviNet firmographics
Firmographics- Name
- NaviNet
- Legal name
- NaviNet, Inc.
- Website
- https://navinet.net
- Company type
- Private
- Founded year
- 1998
- Operating status
- Operating
- Headcount range
- 101–250 employees
- Short description
- NaviNet is a NantHealth subsidiary that operates a HIPAA-compliant web portal connecting U.S. healthcare providers with multiple health plans for eligibility, claims, document exchange, and prior authorization workflows, monetized via tiered AllPayer subscriptions and transaction fees.
- Ownership category
- akta.pro rank
NaviNet industry classification
Industry- Product category
- Healthcare Provider Administrative Software
- NAICS
- Health Care and Social Assistance (62), Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (51821)
- SIC
- Hospital & Medical Service Plans (6324)
- akta.pro primary industry
- HIE Platforms & Network Services (Community/Regional/National) (HLACABAB)
- akta.pro secondary industry
- Consent, Authorization & Data Sharing Governance (opt-in/opt-out, DS4P) (HLACABAG)
Keywords
Where NaviNet is headquartered
LocationHeadquarters
- HQ city
- Boston
- HQ country
- United States
- HQ region
- North America
Markets served
NaviNet business model
Business model- GTM type
- B2B
- Offering type
- Software
- Cost components
- Technology or R&D, Personnel, Operations, Infrastructure, Marketing or Sales
Revenue model
- Core Portal Services: Base portal services are provided at no cost to healthcare providers as part of engagement with NaviNet Subscribers (health plans).
- AllPayer Services (Additional Services): Additional subscription-based and transaction-based fees for AllPayer services including Basic, Premium, and Ultimate tiers. Transaction-based fees are charged monthly based on transactions processed during the previous month.
- Additional Services (Medicare, Prior Auth): Access to Medicare eligibility and billing information services and third-party prior authorization services available for additional charges beyond base portal access.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Freemium | Monthly | Free core portal access for healthcare providers with health plan relationships |
| Subscription | Monthly | NaviNet AllPayer Basic |
| Subscription | Monthly | NaviNet AllPayer Premium |
| Subscription | Monthly | NaviNet AllPayer Ultimate |
| Transaction based/ take rate | Monthly | Transaction-based AllPayer Services |
Go-to-market motion2 records
Distribution channels2 records
Marketing channels3 records
NaviNet product offering
Product offeringCore offering
NaviNet is a web-based healthcare administrative SaaS portal that enables healthcare providers to exchange information with multiple health plans through a single interface. The platform supports eligibility verification, claims management, document exchange, drug prior authorizations (via CoverMyMeds), and patient eligibility/billing services. Core access is free for providers with health plan relationships; subscription tiers (AllPayer Basic, Premium, Ultimate) add multi-plan workflow and transaction-processing capabilities.
Product overview
NaviNet is a unified healthcare administrative platform operated by NantHealth that provides a single portal for healthcare providers to exchange information with health plans, access documents, and manage administrative workflows. The core NaviNet platform is enhanced by AllPayer subscription tiers (Basic, Premium, and Ultimate) that enable multi-plan transaction processing and workflow management. Additional services include CoverMyMeds-powered drug authorization functionality for medication prior authorizations. Registration is free for healthcare providers who verify their identity using a Federal Tax ID.
Differentiator
Problem solved
Functional benefit
Brands
- NaviNet AllPayer Basic: AllPayer subscription service tier for healthcare providers
- NaviNet AllPayer Premium
- NaviNet AllPayer Ultimate
Products and services
- NaviNet Platform Web-based healthcare administrative platform enabling healthcare providers to exchange information with health plans, access patient and practice documents, manage workflows, and process transactions through a single portal. Registration is free for provider offices with health plan relationships.
- NaviNet AllPayer Basic Entry-level subscription tier of the AllPayer Services offering access to multi-plan workflow management and transaction processing capabilities for healthcare providers.
- NaviNet AllPayer Premium Mid-tier subscription service providing enhanced multi-plan transaction processing and workflow automation features beyond the Basic tier.
- NaviNet AllPayer Ultimate Highest-tier AllPayer subscription offering comprehensive multi-plan transaction processing, workflow management, and premium support features.
- CoverMyMeds Drug Authorization Service Drug authorization service integrated within NaviNet enabling healthcare providers to quickly submit prior authorization requests for medications through a partnership with CoverMyMeds.
Quantifiable outcome
- Free registration for healthcare providers
- +1 more outcomes
Companies that use NaviNet
Customer profileSegments3 records
Ideal customer profiles2 records
NaviNet technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Integration1 record
Feature5 records
NaviNet partnerships and signals
Strategic signalPartnerships
Three partnerships are on record, tiered core and supporting.
- CoverMyMedscoreCoverMyMeds serves as a Business Partner providing drug authorization services through the NaviNet platform. NaviNet integrates with CoverMyMeds to allow healthcare providers to quickly submit prior authorization requests for all medications directly within the NaviNet portal. Additional supplemental terms of service govern this integration.
- NaviNet Subscribers (Health Plans)coreHealth plans engage NaviNet to make its services available to contracted healthcare providers. NaviNet is engaged or authorized by health plan subscribers to provide the platform for exchange of healthcare information for payment and administrative purposes. Business Associate Agreements are in place with each subscriber in compliance with HIPAA regulations.
- Business Partners (Service Providers, Clearinghouses)supportingCompany's service providers, third party clearinghouses, and other business partners receive, exchange, and process health information in the provision or operation of Services. These partners are disclosed in the Use Agreement and subject to Business Associate Agreements where applicable.
Recent moves6 records
Expansion highlights4 records
NaviNet competitors and assessment
Company assessmentDirect peers
- Availity: Availity operates a healthcare information network connecting health plans and providers for administrative transactions including eligibility, claims, and prior authorizations. It is the most direct competitor to NaviNet's multi-payer portal model.
- Surescripts: Surescripts operates a nationwide health information network focused on electronic prescribing, prior authorization, and clinical messaging. Its network-effect-driven model and payer-provider connectivity are directly comparable to NaviNet.
- Edifecs: Edifecs provides healthcare data interoperability, EDI processing, and payer-provider collaboration solutions. Its focus on healthcare information exchange and value-based care workflows closely mirrors NaviNet's interoperability positioning.
- Waystar: Waystar offers a cloud-based revenue cycle management platform with eligibility verification, claims management, and prior authorization capabilities. It competes with NaviNet in administrative workflow consolidation for providers.
Broad incumbents
- Change Healthcare (Optum): Change Healthcare, now part of Optum, offers a broad suite of payer-provider connectivity, revenue cycle management, and clinical data exchange solutions. It overlaps with NaviNet's administrative workflow focus as part of a much wider portfolio.
- Experian Health: Experian Health provides revenue cycle management, eligibility verification, and payer connectivity solutions to healthcare providers. It competes with NaviNet in the eligibility and claims management workflow category as part of a broader RCM suite.
Emerging players
- Bamboo Health: Bamboo Health (formerly Appriss Health + PatientPing) provides real-time care coordination and behavioral health data exchange, with growing presence in payer-provider notifications and care transitions, partially overlapping with NaviNet's connectivity use cases.
Market position
Strengths4 records
Weaknesses4 records
Competitive moat5 records
Key risks5 records
Key highlights6 records
Customer concentration
NaviNet social profiles
Digital presenceNaviNet compliance and trust
Trust signalCompliance1 record
NaviNet financial estimates
Financial estimateRevenue estimate
Valuation estimate
NaviNet leadership team
Management profileNumber of profiles
Profiles2 records
NaviNet funding detail
Funding detailFunding overview
Funding rounds2 records
Investors8 records
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
NaviNet M&A and investment
M&A and investmentM&A2 records
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about NaviNet
What does NaviNet do?
NaviNet is a web-based healthcare administrative SaaS portal that enables healthcare providers to exchange information with multiple health plans through a single interface. The platform supports eligibility verification, claims management, document exchange, drug prior authorizations (via CoverMyMeds), and patient eligibility/billing services. Core access is free for providers with health plan relationships; subscription tiers (AllPayer Basic, Premium, Ultimate) add multi-plan workflow and transaction-processing capabilities.
Is NaviNet a public or private company?
NaviNet is a private company. It is classified as corporate owned and is currently operating.
When was NaviNet founded?
NaviNet was founded in 1998. It employs 101 to 250 people.
Where is NaviNet based?
NaviNet is headquartered in Boston, United States, in the North America region.
How does NaviNet make money?
Three revenue lines are on record. Core Portal Services are the primary driver. The others are allPayer Services (Additional Services) and additional Services (Medicare, Prior Auth).
Who are NaviNet's main competitors?
Direct peers on record are Availity, Surescripts, Edifecs and Waystar. Broad incumbents are Change Healthcare (Optum) and Experian Health. Bamboo Health is listed as an emerging player.
Does NaviNet have an API?
No public API is recorded for NaviNet.
What industry is NaviNet in?
NaviNet's product category is Healthcare Provider Administrative Software. Its primary akta.pro industry code is HLACABAB, HIE Platforms & Network Services (Community/Regional/National), with a secondary code of HLACABAG, Consent, Authorization & Data Sharing Governance (opt-in/opt-out, DS4P). Its NAICS code is 62 and its SIC code is 6324.