New Feature Release: Network Status

We’re excited to announce the launch of Network Status - a new capability that lets you define and manage network eligibility rules, so Nirvana can automatically determine in-network or out-of-network status on every eligibility check

Live: https://coverage.meetnirvana.com/network-status

What We’ve Built

Credentialing and billing teams often maintain complex spreadsheets or internal systems to track which payers, plan types, and states their providers are in-network with. This creates manual overhead and introduces risk every time a new patient is verified.

With this release, you can now:

• Input network status rules that apply to your practice and/or individual providers
• Define in-network or out-of-network status rules based on provider & plan details
• Have Nirvana store and manage these rules - eliminating the need for your credentialing or internal teams to maintain them separately
• Automatically receive a network status determination on every eligibility check, plus accurate plan and patient responsibility based on that determination

Why This Matters

Without centralized network status rules, billing teams face:

• Manual lookups to determine if a provider is in-network for a given plan
• Benefits pulled for the wrong network tier, leading to inaccurate patient responsibility estimates
• Increased claim denials from network misclassification
• Extra coordination between credentialing and billing teams

By centralizing network rules in Nirvana, you can:

• Eliminate manual network status lookups at the point of verification
• Ensure benefits are returned for the correct network tier automatically
• Reduce denials caused by in-network / out-of-network misclassification
• Remove the operational burden from your credentialing and billing teams

How to Access

If you are not yet set up with Nirvana, reach out to our team via the Get Started button below. If you are an active Nirvana customer, see details below.

Network status determinations are available via API and OneVerify.

Via the API, a new network_status object will be included in the eligibility response:

"network_status": {

    "is_alert": true,

    "rule": {

        "id": 10,

        "network_status": "IN"

    }

}

You can use this to:

• is_alert - indicates whether the requested benefits (in-network or out-of-network) differ from Nirvana’s network status determination. Use this to flag mismatches before claims are submitted
• rule.id - the specific rule used to make the determination, for traceability and auditing
• rule.network_status - Nirvana’s ultimate determination of network status (IN or OUT)

If no network status rules are configured, the object will be null. This enhancement fits directly into your existing workflow - now with automated network eligibility built into every check.