Inovalon
Verify patient insurance eligibility and benefits in real-time with full featured Revenue Cycle Management via Claims.
Product Summary
Inovalon – Claims & Remits is a comprehensive healthcare revenue cycle management (RCM) solution that supports Medical Attachments, Denials Management, and Financial Reporting. It processes Professional and Institutional claims—including original, resubmitted, and appealed claims—and delivers electronic remittance advice. The platform is enhanced by RCM Intelligence, a cloud-based analytics tool that provides actionable insights into financial and operational performance.
Categories
Billing/RCM Clearinghouse CareLogicCredibleInSync
Product Official Name
Inovalon – Claims & Remits with RCM Intelligence
Capabilities
Submission and tracking of Professional and Institutional claims
Support for original, resubmitted, and appealed claims
Delivery of electronic remittance advice (ERA)
Management of Medical Attachments
Denials Management workflows
Financial Reporting and analytics
Integration with RCM Intelligence for trend identification, predictive modeling, data visualization, and performance management dashboards
Vendor Overview
Marketing Information
Inovalon’s Claims & Remits service streamlines the claims lifecycle, improving accuracy and speed of reimbursement. Paired with RCM Intelligence, it empowers healthcare organizations to make data-driven decisions by surfacing key financial and operational trends. This combination enhances visibility, reduces denials, and optimizes revenue performance.
When to Use the Product
When managing high volumes of Professional and Institutional claims
For organizations seeking to reduce claim denials and improve resubmission efficiency
When electronic remittance advice is required for reconciliation
To gain deeper insights into RCM performance through advanced analytics
For strategic financial planning and operational optimization
Billing – Real Time Eligibility CareLogicCredibleInSync
Product Summary
Verify patient insurance eligibility and benefits instantly to support accurate billing, reduce denials, and improve point‑of‑service decision-making.
Inovalon’s Eligibility Verification software delivers real-time insurance eligibility and benefits verification services that seamlessly integrate with Revenue Cycle Management (RCM) workflows.
The solution queries payer eligibility systems and returns real-time responses containing information, such as active coverage, plan details, copay, deductible, and service-specific benefit requirements.
This immediate access to insurance data enables front‑office, billing, and clinical teams to confirm patient coverage before services are rendered—reducing claim rejections, minimizing eligibility‑related denials, and improving reimbursement timelines.
The solution is designed for high performance, broad payer connectivity, and operational efficiency across behavioral health and medical practices.
Product Official Name
Inovalon – Eligibility Verification
Capabilities
Real-time verification of patient insurance eligibility across major payers
Retrieval of coverage status (active, inactive, terminated)
Access to plan details such as copay, deductible, coinsurance, and benefit limits
Support for service‑specific eligibility checks (mental health, substance use, primary care, specialty care, etc.)
Automatic eligibility inquiry at check-in or appointment scheduling
Integration with front‑office workflows for coverage confirmation before service delivery
Documentation of eligibility responses in the patient record for audit and billing support
Reduction of eligibility‑related claim denials through upfront verification
Vendor Overview
Marketing Information
Inovalon’s Eligibility Verification software enables organizations to validate patient insurance coverage within seconds, supporting accurate billing and a smoother patient intake experience.
By confirming eligibility at the point of service, organizations reduce administrative burden, minimize billing delays, and avoid common causes of payment rejections.
The solution enhances revenue performance by strengthening coverage verification processes and enabling staff to proactively identify changes in insurance status—before claims are submitted.
When to Use the Product
Use Eligibility Verification when:
Verifying patient insurance coverage before an appointment or during check‑in
Reducing eligibility‑related claim denials
Identifying changes in payer coverage or plan status
Determining copay, deductible, and benefit responsibility upfront
Confirming active coverage for mental health, behavioral health, and medical services
Supporting front‑office staff with real-time eligibility insights
Ensuring cleaner claims and improving first-pass acceptance
Enhancing operational efficiency across patient intake, scheduling, and billing workflows