Qualifacts and Inovalon
Integrate Powerful RCM Tools into Your Organization
Qualifacts has partnered with Inovalon to offer our customers powerful revenue cycle products for an easier, more efficient way to manage your revenue cycle.
Inovalon’s revenue cycle management (RCM) solutions streamline and automate every aspect of RCM. Ranging from eligibility verification, patient access enhancements, patient payment applications, claims submissions, workflow analytics, and more, each solution helps providers simplify the complexities of RCM.
Claims Management Pro
For most providers, manual processes are the leading contributor to labor overages and RCM errors that cost time, money, and result in patient dissatisfaction.
There is a better way. Claims Management Pro is a comprehensive SaaS-based claims management solution that far outpaces the average clearinghouse. This solution puts you in control of front-end claims cycle activities, with a 99% clean claims rate*. Its combination of real-time eligibility checks, claim status tracking, audit and appeals workflows, and ease of payment posting focuses your labor activities to get cash flowing. A single log-in and customizable dashboard gives access to all payers, including Medicare, Medicaid, and commercial insurance.
Plus, Claims Management Pro is an easy-to-use application compatible with all leading web browsers. Implementation is easy, with no complicated technical requirements to get started.
Check out the highlight video here.
* Inovalon internal reporting, Claims Management Pro, July 2022
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Boost efficiency with instant, clear claims information displayed on intuitively designed dashboards.
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Reduce labor and shorten days in accounts receivable with automated functionalities.
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Increase accuracy and claims revenue with streamlined workflows that decrease the opportunity for human error and automate audit and appeals processes.
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Gain operational insights and identify denial trends with advanced analytics and reporting.
- Gold-standard clean claims: Achieve a 99% clean claims rate or better. If a claim is rejected by a payer, it is immediately routed to a work queue with clear correction guidance, minimizing days-to-submission.
- Continually updated and customizable rules engine: Scrubbers always contain the most up-to-date CMS and commercial payer rulesets. Facility-specific rules are easy to input and revise.
- Easy secondary claims submission: Electronically submit secondary claims from the same system as primary claims, utilizing primary claim information. Stop timely filing write-offs for secondary payers.
- Audit and appeal automation: Decrease days in A/R with automated workflows for audit responses, appeal submissions and ADR tracking. Receive alerts, autopopulate submissions, and follow claims from start to finish.
- Accelerated payment posting: Payment information for all payers is centralized onto a single application. Access and download ERAs with one login.
- Know in Advance: Accurately plan cash flow with advanced revenue forecasting.
- Detect Workflow Patterns: Identify denial trends and common errors with analytics and reporting that do the investigating for you.
- Prevent Write-Offs: Leverage automated secondary claims submissions to prevent timely filing write-offs.
- Enhance Audits and Appeals: Increase claims revenue with automated workflows for faster, more successful audits and appeals.
Insurance Coverage Discovery & Demographic Verification
The data collected during patient registration is crucial for navigating patient treatment, care, and the Revenue Cycle Management (RCM) process.
Insurance Discovery searches numerous national vendors to identify any recent insurance coverage a patient may have. It ensures every applicable payer is identified for a claim by using robust algorithms to search patient information against public and private payers, identifying primary, secondary, and tertiary coverage with confidence scoring. The returned payer results can be used to run a current eligibility check to verify active coverage.
Demographic Verification is a cloud-based solution that is included as part of Insurance Discovery. It helps avoid costly issues caused by incomplete or inaccurate patient data (name, date of birth, address, phone, SSN), which reduce medical errors and treatment delays. If a patient returns no prior insurance coverage and is self-pay, the confirmed demographic details may be used for accurate patient collections.
This solution is a stand-alone add-on product. It can be purchased independently of any other Inovalon solution, including Eligibility Verification Workflow, Claims Management Pro and/or RCM Intelligence. Qualifacts customers do not have to use Inovalon as their clearinghouse to purchase this add-on.
- Recover lost revenue: Put payments back in the hands of payers, not patients. Move more accounts from self-pay and bad debt into approved and paid claims with accurate insurance information.
- Simplify downstream revenue cycle processes: Understand coverage and payer requirements for appropriate care delivery to patients.
- Save your billing staff significant time: Reduce the burden of repeated attempts to contact patients.
- Reduce days in accounts receivable: Bill the appropriate payer with accurate patient information from the start of the claim’s lifecycle, reducing reimbursement delays & shortened A/R cycles.
- Improve cost-to-collect ratios: Replace manual individual insurance determination searches with quick batch inquiries that identify payers for multiple patients with confidence.
- Provider facilities can verify name, date of birth, Social Security number, address, and phone number before running an eligibility check.
- Billing teams can utilize the application to gather missing or incomplete information to confirm payer and coverage data for the patient before submitting the claim to prevent denials or disruption to the patient’s care plan.
- Easy identification of primary, secondary, and tertiary coverage, including active government and commercial insurance coverage.
- Advanced algorithms build a list of probable payers that are most likely to cover each patient.
- Batch search capabilities speed up the search process, finding coverage for many patients at one time.
- Accelerate the time to patient care
- Maintain clean patient census data
- Reduce days in accounts receivable
- Get better results for patient coverage
Eligibility Verification
With this proven SaaS solution, you get fast, automated access to detailed eligibility and medical benefit information from hundreds of commercial, Medicare, and Medicaid payers, including Medicare supplements, Medicare Advantage, and state Medicaid plans.
Set up and save a variety of eligibility requests and render filters by payer to ensure maximum efficiency. Eligibility Verification also retains all 271 reports, so you can retrieve past 271s for denial management and the appeals process.
- Comprehensive eligibility information from Medicare, Medicaid, and more than 650 commercial payers.
- Eligibility Verification provider transactions among more than 1 billion processed annually.
- Over 47,000 sites of care use this and/or other Inovalon applications.
- Single interface for eligibility verification for more than 650 health plans—sign in with one username and password to access your payers.
- Shortcuts to the most common and successful search-by-payer criteria.
- Customizable eligibility response pages can be saved by payer for easy access later.
- Comprehensive data analysis by payer to ensure the most accurate eligibility and benefit determinations.
- Eligibility status alerts let you receive a notification when other insurance plans are detected for a patient.
- Re-run features let you resend an eligibility request to revalidate insurance coverage.
- Eligibility transaction history lets you search by patient or other filtering options.
- Eligibility state icons indicate active or inactive coverage.
- Ability to filter Service Type Code (STC) queries and responses and save your favorites organized by payer.
- Multiple search criteria options help you confirm eligibility, even with limited data elements.
- Coordination of benefits feature assists with identification of Medicare replacement plans, secondary payers and Medicare as secondary payer.
- Benefit information includes behavioral, chiropractic, and dental when relevant.
- Minimal system requirements make implementation easy with minimal IT involvement. These web-based services are compatible with current versions of industry-leading browsers.
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More informed decision-making with identification of Medicare replacement plans and secondary payers.
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Enhanced record-keeping via eligibility transaction history (271s).
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Faster claim payments thanks to streamlined eligibility and benefit confirmation.
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Significant time savings with less administrative workload.
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Increased revenue through eligibility validation.
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Faster reimbursement and improved cash flow, with eligibility confirmed before services are rendered.
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Fewer claim rejections as the correct payer is billed the first time.
RCM Intelligence
Our RCM Intelligence solution provides proactive insights into your revenue cycle health.
Comprehensive analytics facilitate smarter decisions for better operational productivity.
These analytics empower decision-makers with actionable intelligence to help improve cashflow and profitability in one application that’s compatible with any clearinghouse.
• Improve first-pass yield on all claims with detailed denial source insights.
• Strengthen cash flow by predicting and preventing denials with advanced visualization tools.
• Eliminate manual report generation with pre-built, automated reporting.
• Facilitate better payer negotiations with data on payer-specific denials, reimbursement, and turnaround times.
• Boost staff efficiency and engagement by identifying repetitive tasks that can be automated.
• Make better-informed decisions with actionable dashboards that deliver quick, comprehensive views of your data.
• Reduce A/R book and aging through payer performance monitoring.
- Performance dashboards give executives the data they need to truly understand organizational revenue performance. User productivity reports help identify opportunities to enhance overall RCM efficiency.
- Scorecard dashboards help uncover potential workflow problems and drive continuous process improvements. The ability to track denials by type and payer-specific denial-causing categories helps strengthen denial prevention and payer performance.
- Cash projection dashboard displays exported claim and projection volumes and details, with a concentration on payment forecasting. Projected payment is calculated with algorithms that leverage historic payment information.
Inovalon Customer Testimonials
I like the process in Inovalon’s Claims Management Pro because it’s very easy to click into the claim that was kicked out, and it tells you exactly what you need to correct or what’s missing. And, depending on what the error is, Claims Management Pro gives you the option to override it if it doesn’t pertain to your specialty.
When we moved to Inovalon Claims Management Pro, we started having higher numbers of clean claims rate.
I’m most excited about Qualifacts partnering with Inovalon because we can hit submit and CareLogic sends claims right to Inovalon. This will save time and create efficiency in our claims submittal process.
Inovalon’s onboarding and implementation process was smooth and seamless.
