10. Name: NaviMedix
Location: Cambridge, MA
Why it matters:
If NaviMedix can live out its vision, medical staff members who work with insurers will be doing handsprings. The Cambridge, MA-based companyâ€™s hugely ambitious intent is to do what no one has been able to manageâ€”give providers a single access point for doing both claims and non-claims transactions such as referrals, re-credentialing and patient eligibility checking with every health plan in the U.S. Weâ€™re not talking about traditional EDI-based insurance communications following X.12 ANSI standards; instead, NaviMedix uses XML-based APIs that, execs say, work very handily with just about any end-point system. At the same time, NaviMedix is using its gatewayâ€”the companyâ€™s NaviNet portalâ€”to give practices the clinical info they need from non-insurance players such as pharmacy benefit managers and disease management. This allows the system to deliver updates to the clinician at just the right moment. (When Suzie Jones visits, the system might remind the doctor, for example, â€œSuzie needs a flu shot but she hasnâ€™t had one yet.â€) The company already has 14 plans on board, and it is working with national insurers Aetna and CIGNA as well as regional plans.
What to look for:
In addition to a big jump in regional plans signing on, expect to see a few more major national insurers sign up in 2007 as well. (And if theyâ€™re making big headway, expect to see health portals like WebMD jump in and offer some "me too" products as well.)