NaviNet

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.

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

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

• Healthcare communications
• Health plan portal
• Provider administration
• Medical claims exchange
• Eligibility verification

Headquarters

HQ city

Boston

HQ country

United States

HQ region

North America

Markets served

GTM type

B2B

Offering type

Software

Cost components

Technology or R&D, Personnel, Operations, Infrastructure, Marketing or Sales

Revenue model

1. Core Portal Services: Base portal services are provided at no cost to healthcare providers as part of engagement with NaviNet Subscribers (health plans).
2. 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.
3. 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

Go-to-market motion2 records

Distribution channels2 records

Marketing channels3 records

Core 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

Segments3 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration1 record

Feature5 records

Partnerships

Three partnerships are on record, tiered core and supporting.

• CoverMyMedscoreTechnology or IntegrationCoverMyMeds 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)coreChannel Partner/ Reseller/ DistributorHealth 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)supportingTechnology or IntegrationCompany'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

Direct 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

• Xx.com/NaviNet
• LinkedInlinkedin.com/company/navinet

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 records

Funding overview

Funding rounds2 records

Investors8 records

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A2 records

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about NaviNet