Claims Management Medicare Pro™ helps healthcare organizations manage the complexities of Medicare Part A claims. Built for acute and post-acute providers participating in the Medicare program, it gives revenue cycle teams real-time access to the Fiscal Intermediary Standard System (FISS) to create, correct, and resubmit claims, monitor payments, and manage claims throughout the Medicare reimbursement process. It is best suited for organizations that need Medicare-specific claims management, reporting, and workflow tools in addition to direct FISS access.
Managing Medicare claims often requires specialized expertise, multiple manual processes, and ongoing attention to claim status, eligibility, payments, and documentation. Claims Management Medicare Pro helps organizations identify and correct issues before they delay reimbursement while providing greater visibility into claims, accounts receivable, and payment activity. It also automates key administrative tasks, giving revenue cycle teams more time to focus on high-priority work instead of manual follow-up. The solution also brings a broad range of Medicare workflows together in one application, including Payment Error Rate Measurement (PERM), Comprehensive Error Rate Testing (CERT), and more.
Key capabilities include:
Create, correct, and resubmit Medicare Part A claims in real time through direct access to FISS, with guided prompts that assist with claim corrections.
Monitor claims and revenue activity using customized reporting, claims aging analytics, payment forecasting, and up to 12 months of visibility into unpaid claims.
Manage Medicare billing requirements with automated credential management, Medicare eligibility verification, Medicare Secondary Payer status updates, and support for Notice of Admission (NOA) and Notice of Election (NOE) processing, sequential billing for skilled nursing facilities and hospice, and secure electronic documentation submission for Additional Documentation Requests (ADRs), Recovery Audit Contractor (RAC) audits, and appeals.
Identify potential reimbursement issues earlier with real-time payment visibility, overnight eligibility change summaries, and detailed reporting that highlights claim, eligibility, and payment issues.
Track key performance indicators to help maintain awareness of potential revenue leakage and billing performance.
By combining real-time FISS access, claims management, reporting, and payment visibility in a single application, the solution gives organizations greater insight into every stage of the Medicare claims process. This helps teams address issues before they affect reimbursement and improve oversight of Medicare billing activities.
Customer experience:
"I've been working in this business for over 20 years, and Medicare is still using the DDE FISS system, which is very challenging for the new generation to learn. I've never found another system to get claims to Medicare. Claims Management Medicare Pro is amazing. We can do the same thing, but in a better way."
— Marco Ochoa, A/R Manager, MGM Healthcare
Claims Management Medicare Pro is part of Inovalon's revenue cycle management suite, which was top rated by Black Book Research. Based on evaluations from more than 1,300 hospital and health system finance and revenue cycle leaders, the suite earned recognition for its full provider cloud RCM platform breadth and eligibility, benefits verification, and real-time payer rule interpretation capabilities.
Average Rating: 4.0/5.0
Total Reviews: 5
How Do G2 Users Rate Inovalon Claims Management Medicare Pro?
-
Has the product been a good partner in doing business?: 6.7/10 (Category avg: 8.4/10)
-
Clearinghouse Integration - Healthcare Claims Management: 10.0/10 (Category avg: 8.4/10)
Who Is the Company Behind Inovalon Claims Management Medicare Pro?
-
Seller: Inovalon
-
Company Website:
-
Year Founded: 1998
-
HQ Location: Bowie, Maryland, United States
-
Twitter: @InovalonInc
1,521 Twitter followers
-
LinkedIn® Page: www.linkedin.com
3,336 employees on LinkedIn®
Who Uses This Product?
-
Company Size: 60% Small, 40% Medium
