NaviNet Claims - Electronic Claims Solution Specialists

First Name

Provider ID#

Individual NPI

Are you already a NaviNet User?

If so, please enter your NaviNet Username:

NaviNet Claims software system requirements:

Windows 2000 or Greater How do I check?
256 Megabytes of Memory (RAM) How do I check?
High-speed Internet Connection (broadband: cable, DSL, T1, etc.)

Does your computer meet these minimum requirements?^*

Yes No

Do you have a practice management system?^* What is a Practice Management System?

Yes No

What is the name of your practice management system? What is a Practice Management System?

Can your practice management system create a text file ANSI 837 or print image file?

Yes No

Are you billing Professional (CMS/HCFA) or Institutional (UB) Claims?^*

Professional Institutional

What is the Primary Insurance Company you'll be submitting to?^*

How would you like to use NaviNet Claims?^*

I’d like to submit claims to over 3000 payers across the country for a small monthly charge. Click here to see a list of available payers.
I’d only like to submit claims to the list of sponsored payers. Click here to see a list of available payers.

Paper Claims Option?

Yes No

Please provide us with some information about your office and how to contact you.


^*Office Name:
^*Tax ID:
^*Address 1:			Salutation:
Address 2:			^*First Name:
^*City:			^*Last Name:
^*State:			^*Phone:
^*Zip Code:			^*Email:

When is usually a good time to contact you during the day?^*

How many providers are there in your practice?

Provider Information

Terms and Conditions^*

I understand that in the event that I submit claims to a payer not accepting electronic claims, that my claims will be routed automatically on paper to those payers. I understand NaviNet, Inc. will charge a small service fee associated with this service.

I accept the terms and conditions of the NaviNet, Inc. User Agreement and this Agreement. Billing Period starts on commencement of installation. Payments due to NaviNet, Inc. under this Agreement shall be paid within 30 days of NaviNet, Inc.'s monthly invoice date. Nonpayment within that time shall be grounds for immediate termination of this Agreement by NaviNet, Inc. It is understood and agreed that NaviNet, Inc. shall have no obligation to process any such claims or other transactions after termination or cancellation.

I understand that I can terminate this Agreement or any service upon 30 days written notice.

I have read the Terms and Conditions and I do accept them.

User Agreement^*

Please take the time to review the NaviNet Claims User Agreement carefully before you submit your request.

I have read the NaviNet Claims User Agreement and I do accept it.