NaviNet Care Gaps Frequently Asked Questions

A Gap in a Member's Care is identified by Member Criteria, specific Diagnosis Codes, and/or CPT Procedure Codes. 

A NaviNet Security Officer in your office can adjust a user's access to NaviNet transactions functionality for a particular plan in NaviNet. When a user should not have the ability to view alerts when using the Eligibility transaction, the Security Officer can disable their permissions for that specific transaction.

When the "NO" button is selected on the permission screen a user will no longer have access to view any alerts. To reset your permissions, go to the Reports Transaction and select Clinical Reports. When you request the Member Stand alone Report you will see the Permissions Screen. When you select "YES" you indicate you should have access to this data. This will reset your access to alerts in the Eligibility Transaction as well.

The plan loads new claim data on a monthly basis so it could take about 3-4 weeks for the Care Gaps data to be refreshed with new claim information. Once the claim information is loaded, the Care Gap status will be changed from Missing or Overdue to Up-to-Date.

In order to use the downloadable CSV file type you need to have Microsoft Excel loaded on your workstation. If you do have Microsoft Excel and are still having a problem loading the report you may have pop-up software that is blocking this action. To bypass a pop-up blocker, press the Control Key (Ctrl) down as you click on the Select button and continue holding it down until the report starts to load.

There are several possible reasons for this. First, the initial reports for your plan were developed for primary care physician (PCP) practices. If you are not part of a PCP practice you will not see reports at this time. Second, the initial reports developed are in the Clinical Reports and Financial Reports categories. You will not see reports in the Administrative Reports category. Third, your security settings may not authorize you to see reports.

We welcome ideas for new reports that can help our providers. Please forward any ideas for these to your provider account representative.

Most care gaps can be cleared off your list by submitting a claim for the service that is required to meet that care gap. In some cases, you may not submit a claim because, for example, the service has been delivered by another provider. In these cases, you should print on the worksheet an explanation of the reason the gap should be considered met, have a physician sign and date the sheet, and fax to the number listed.

To receive credit for meeting the care gap you typically need to submit a claim. If you have submitted a claim that was accepted the gap will come off the report. The care gap report data is updated monthly three to four weeks after the end of the month. This lag time may delay the removal of the gap from your report.