Frequently Asked Questions

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What is navces?

navces is a Patient Advocacy Service created by Doctors to protect our members by exposing the truth about price and quality variation between medical providers. We guide patients to make informed decisions when seeking medical care so they find you, navces recommended High-Value Medical Providers, at a Fair Price.

Can navces save our company and employees money?

Yes, when following our “Best Practices,” employers can see an ROI of 4:1 with just 20 percent utilization and a 10:1 return on navces Incentive Spend. In combination with our data partners, navces has identified 1,500 common medical procedures (90 percent of employers group medical spend) that present the deepest savings opportunities when using navces recommended High-Value Medical Providers. Employee members save when accessing High-Value, Fair-Priced medical service under the health plan deductible and out-of-pocket maximum.

What does navces do?

We use multiple data points to navigate and provide easier access to navces recommended in-network High-Value Medical Providers at a Fair Price—while saving members money on needed healthcare services.

navces is a premium “concierge” service that helps ease the burden of finding navces recommended in-network High-Quality, High-Value Medical Providers at a Fair Price for an eligible medical test (CT scan, MRI scan, PET scan, Ultrasound, etc.), procedure (Colonoscopy, EGD, etc.), surgery, or if you are an expecting mother.

Employee members may be eligible for monetary rewards that can be used towards medical expenses for following our professional guidance.

How is your data derived?

All Pricing is derived by analyzing commercial claims data. Prices are based on allowed amounts paid by commercial insurance carriers based on their negotiated in-network rates.

Quality data is harvested with multiple data points and independent clinical research. Data Sources include the CMS Standard Analytic File—three years of data scores calculated directly from claims data, risk, and volume, adjusted with additional metrics.

Hospital quality rankings are based on national rankings by the medical test, procedure, or surgery. These rankings are listed from 0–100% for all US hospitals.

Patient savings ratings track doctor-specific referral patterns.

What procedures are rewards-eligible?

Based on best practices, listed below are just a few of the over 440 navces procedure categories and dollar amounts for the navces Incentive Rewards Program for shoppable procedures. 

Most diagnostic medical tests, procedures, treatments, and surgeries are rewarded and eligible if using navces recommended in-network High-Value Medical Providers.

Who is eligible to earn a navces Incentive Reward?

The employee, spouse, or dependent that receives an eligible service is eligible to earn a navces Incentive Reward through this program.

Are there multiple navces Incentive Rewards options available?

Yes, because every employer and insurance program is different. We have customized navces Incentive Rewards Programs for Self-Funded, Level-Funded, and those employers that are fully insured based on our “Best Practices.” The programs available are as follows:

  1. Standard Rewards (the lowest monetary reward level, mostly for Fully Insured plans)
  2. Engagement Rewards (the highest incentive monetary reward level)
  3. Customized Rewards (HRA or by shoppable procedures; targets specific risk management) 
  4. No Rewards
How is a navces Incentive Rewards fulfillment handled?

navces handles fulfillment when the member submits (1) their Insurance Explanation of Benefits (EOB) and or (2) the Bill from the Provider, Doctor, Facility, and/or Hospital as proof they were treated a Go Green or Yellow lever Healthcare Bluebook provide or a recommended provider listed in your navces  High-Value Providers Report you revived from the Care Guidance team.

Members must send all the provider documents to rewards@navces.com or to their assigned navces Care Guidance Patient AdvocateThe documents are reviewed for eligibility, and then navces Incentive Rewards are issued to qualifying members.

Are navces Incentive Reward payments subject to taxation?

navces does not offer tax advice but encourages clients to consult with their tax advisors and confirm the most appropriate rewards tax treatment for their organization. navces may support clients, regardless of the tax decision.

How does an employee know if they are eligible for the navces Incentive Reward?

The employee MUST contact navces before they seek testing or treatment or use the navces shoppable procedures app to identify the provider in advance of the medical treatment, test, or surgery. They must call 1-(833) 4-navces (462-8237), email rewards@navces.com, or contact one of our navces Care Guidance Patient Advocates.

What does the employee, spouse, or dependent receive?

navces Incentive Reward checks are sent along with a congratulatory letter. For dependents under age 18, the information is sent to the employee. The congratulatory letter includes ideas and steps encouraging positive behavior in handling your health for the future.

Is there a cost associated with the navces Incentive Rewards Program?

Yes, the employer is responsible for the costs of the navces Incentive Rewards the employee receives. The rewards cost is billed on a monthly basis to the employer or is drawn against the established rewards retainer deposited at the start of the navces Incentive Rewards Program.

Can a member's eligibility for navces Incentive Rewards expire?

Yes, all eligibility documents for navces Incentive Rewards must be submitted within sixty (60) days from the date of service to be eligible for the rewards.

How does a member receive their navces Incentive Rewards?

navces handles all navces Incentive Rewards fulfillment. We mail it to the home address of the member with a congratulatory letter rewarding them for using a navces recommended High-Value Medical Provider. Checks or Check cards will be addressed to the employee, regardless of which family member received care.

Can members receive multiple navces Incentive Rewards?

Yes. Employee members can receive multiple navces Incentive Rewards for procedures rendered on the same day. For example, a patient may need a Knee MRI scan and a Hip MRI scan on the same day. In this case, the patient would receive a separate reward for using navces recommended High-Value Medical Providers for both of the separate services.

Are navces Incentive Rewards based on clear attribution?

It’s a fact that navces Incentive Rewards increase utilization. When members are rewarded for using navces to shop for, schedule, and receive care from a navces recommended High-Value “Green” Medical Providers, utilization and related savings are quantified through clear attribution between provider searches and completed procedures.

How does navces engage my employees and encourage them to participate?

navces is a one-stop-shop for access to engagement materials for distribution to your employees. We also provide year-round engagement through postcards, optimized email and text campaigns to members, and the administration of the reward as a monetary incentive as well as participation in raffle prizes.

Can members receive navces Incentive Rewards if they are no longer an employee?

The member must be a current employee or active under COBRA Health Insurance coverage at the time of navces Incentive Rewards processing to receive the reward. You as the employer reserve the right to modify or discontinue the navces Incentive Rewards Program at any time.

Does an employee have to use a navces recommended High-Value Medical Provider?

No, employees under the health plan can use any provider of their choice. However, to be eligible for navces Incentive Rewards, they must see a navces recommended High-Value Medical Provider recognized by the navces Care Guidance Team or in the HCBB App. navces is not a substitute for a medical provider. navces provider recommendations are based on CMS and MIPS Scores for Quality Rankings in combination with the fairest prices. Employee members can and should retain their own personal physician, therapist, and medical professional for purposes of obtaining such medical, therapeutic, or surgical advice if and when it is needed and appropriate.

What are the steps needed for Employees/Members to get navces Incentive Rewards?

To see if you are eligible, you MUST contact navces before you seek testing or treatment. You can call (833) 4-navces or (833) 462-8237, or email rewards@navces.com.

Step 1. Go to www.navces.com, call (833) 4-navces or (833) 462-8237, or email rewards@navces.com. 

Step 2. Your navces Patient Advocate will contact you to confirm what test or procedure is needed and open a navces Care Guidance Ticket.

Step 3. Your navces Patient Advocate will find you navces recommended in-network High-Value Medical Providers focused on quality and cost.

Step 4. You can choose any one of the navces recommended in-network High-Value Medical Providers.*

Step 5. Once completed, members will send (1) their Insurance Explanation of Benefits (EOB) and (2) the Bill from the Provider, Doctor, Facility, and/or Hospital to us at rewards@navces.com. You can also fax it to us at (786) 471-1078.  

Note: All navces Incentive Rewards supporting documents must be submitted to navces within sixty (60) days from the date of service to be eligible.

*Members may choose any provider they wish but must use a navces recommended in-network High-Value Medical Provider to be eligible for the navces Incentive Rewards Program.

How can I get more information about the navces Incentive Rewards Program?

If you have any questions about the navces Incentive Rewards Program, please contact us at www.mynavces.com, call (833) 4-navces or (833) 462-8237, or email info@navces.com.

navces is not an insurance company or provider. navces, LLC operates independently of your insurance company and your employer. We do not provide medical advice or treatment. In an emergency, contact 911 or go to the nearest emergency room before calling navces for assistance.