Patient Claims & Billing

All-Payer Revenue Cycle Management

Keep revenue flowing with a powerful tool that helps staff focus on real-time eligibility checks, claims status tracking and simple payment posting for both government and commercial claims.

Medicare Revenue Cycle Management

Automate your Medicare billing management with specialized software that corrects complex and multi-step claims, flags receivables at risk and allows you to perform easy eligibility look-ups.

Patient Payment

Patient Payment Management is a comprehensive patient payment software that enables you to capture more revenue and improve patient satisfaction.

Revenue Cycle Management Analytics

Improve first-pass yield on all claims. Inovalon All-Payer RCM Intelligence delivers analytic dashboards to identify performance trends, enabling decision makers to easily discover, predict, visualize, model, and manage data all in one application.

All-Payer Claims Management

Our easy-to-use electronic claims management application allows users to submit, edit and receive claims for Medicare, Medicaid and thousands of commercial insurance companies – all in one place.

Patient Statements

Inovalon Patient Statement Management software provides your patients easy-to-read breakdowns of outstanding balances, with statements white labeled to your organization.

Medicare ADR Submission

Simplify your process of secure submission, tracking, and reporting for Medicare claim review programs. This specialized software features connectivity to multiple Medicare esMD programs including ADR, RAC Audits, first- and second-level appeals, PERM, CERT, and more.

Medicare Claims Management

Medicare File Submission is a secure claims submission and remittance advice solution, giving you fast, automated processing and payment of Medicare claims.

Patient Access

Patient Registration

Reduce downstream denials and reimbursement delays through accurate patient data collection at intake. Empower staff to validate patient identity, verify eligibility, and identify all available insurance coverage, all within a few steps powered by a single patient registration software application.

Healthcare Insurance Coverage Discovery

Insurance Discovery reduces uncompensated care and underpayments by identifying active billable coverage previously unknown to the provider. Using sophisticated search capabilities, this solution identifies if patients have multiple active payers to help boost reimbursement opportunities.

All-Payer Health Insurance Eligibility Verification

Eligibility Workflow streamlines patient access and billing workflows by enabling staff to assign and prioritize patients, payers, and tasks during eligibility verification. This technology goes beyond basic eligibility needs, providing a dashboard to confirm, manage, and store every inquiry.

Healthcare Propensity to Pay

Realize the power of patient identity verification combined with custom propensity to pay scoring in one easy-to-use, cloud-based healthcare application. Lower the risk of uncompensated care and collect more revenue with more patient data readily available to make better-informed billing decisions.

Medicare Eligibility Verification

Get fast, detailed eligibility status and medical benefit information, without the hassle of juggling multiple login IDs and passwords. Eligibility Verification Medicare software enables you to submit inquiries 24/7 and receive real-time responses.

Medicare DDE/FISS Connectivity

Direct Data Exchange Verification delivers secure, online connections for Part A and Part B providers. If you need connectivity to DDE through the Professional Provider Telecommunication Network (PPTN), Regional Home Health and Hospice Intermediary (RHHI), or Claim Status Inquiry (CSI), we have you covered.

Patient Engagement

Telehealth

Inovalon’s Virtual Care software is user-friendly, reliable, and built by a team of healthcare experts with the full patient journey in mind. The solution easily integrates with eligibility, claims, and patient payment tools powered by the Inovalon ONE Platform, so you can bring key care delivery functions into one place.

• Chocta Nation Health Care Center (OK)
• Guardian Angels Senior Services
• Marshall Medical Center (CA) 
• Phelps Memorial Health Center
• Quality Care ER (TX) 

Infection Prevention & Control

Prevent infections and stop the spread with non-intrusive screening and automated protocol adherence.

Healthcare-associated infections pose a risk to any care environment. The care.ai Platform effectively reduces that risk by using AI-powered sensors to screen those who enter the facility and also ensures safety protocols are followed.

Increase Confidence

Gives patients and staff the peace-of-mind knowing the most advanced technology is deployed to keep the facility safe.

Reduce Costs

Mitigates the need to use costly human resources for tasks better suited to autonomous solutions.

Improve Processes

Provides real-time insights from continuous monitoring to ensure proper protocol is always being followed.

Simplify Compliance and Reporting

Provides a unified view from the IPC Command Center Module making it easier to generate compliance reports while saving time from manually searching and compiling data.

Smart Entry - Symptom Attestation and Vaccine Compliance

Protect your facility from infectious disease with contact-free entry screening and check-in. The care.ai Smart Entry™ solution screens every person who enters for skin temperatures, symptoms and vaccine compliance.

Intelligent Sensors Track and Trace Everyone Inside The Facility

By deploying multiple intelligent sensors throughout the facility, care.ai can track and trace everyone inside the facility. If an infectious disease exposure occurs, everyone who has been exposed can be quickly identified and notified.

Smart Spaces - Ensure IPC Protocol Adherence

care.ai autonomously monitors patient rooms and common areas for safety protocols such as hand hygiene, PPE efficacy and sanitization compliance. Care team members receive real-time feedback, and non-adherent behavior is documented.

IPC Command Center - Monitor and Improve Processes In Real Time

Receive IPC status alerts and other actionable data in real-time through a single view inside care.ai’s IPC Command Center. Regulatory, compliance, and audit reports are easily generated.

Patient and Protocol Monitoring

Stay continuously aware by monitoring your care environment for conditions that require intervention or processes that need improvement.

Staff shortages present challenges when trying to deliver the best care. The care.ai Platform works as an extra set of AI-powered eyes and ears, monitoring and learning in real-time so care teams can be more proactive and less reactive.

Early Warning Capabilities

Automatically detects indicators of potential risks to bring help as promptly as possible, before an adverse event occurs.

Time For More Quality Care

Ambient Intelligent Monitoring lifts the burden of routine tasks away from care teams, allowing them more time for personal interactions with patients.

Rapidly Scale Up Care

By enabling care providers to monitor many patients at one time, remote monitoring helps rapidly scale up care.

Enhance Safety

Remote monitoring capabilities are built into each room, enabling patients and providers to maintain social distancing while still providing care.

Virtual Care

Allow care teams to do more, be more present and provide a better patient experience through the use of on-demand virtual care.

Virtual care enables patients to receive healthcare in ways that provide more convenience and value. The care.ai Platform connects patients with care teams in a meaningful and impactful way, allowing for a positive continuum of care.

Predict, Prevent and Protect

With the largest machine learning behavioral dataset for healthcare, care.ai protects patients and predicts problems before they escalate.

Convenience for Care Providers

Avoids time-intensive on-site visits for care providers by offering more efficient way of delivering care, while maintaining patient satisfaction.

Timely Access to Care

Creates deeper relationships between care providers and patients, allowing for more timely interventions.

Real-Time Intelligence

Alerts care teams immediately if potential problems arise, directly to their own smart devices.

Workforce Optimization

Automate burdensome, manual tasks while improving processes in real-time and optimizing performance.

Healthcare organizations shouldn’t have to choose between efficiency and quality. The care.ai Platform automates manual tasks, creating efficiencies that improve the quality of care while achieving higher compliance rates.

Improve Processes

Continuous monitoring delivers real-time insights and reporting to ensure proper protocols are always being followed.

Single-Click Reporting

Delivers a unified view across the organization, saving hours of time in collecting and organizing data for reporting purposes.

Make Better and More Timely Clinical Decisions

AI and machine learning replaces countless hours of menial tasks, allowing care providers to focus more on their patients.

Quickly Adapt to New Regulations

Provides customizable configuration to fulfill frequently evolving compliance and regulatory mandates.

The World’s Most Advanced Virtual Nursing Platform

Enable Virtual Nursing by leveraging the most advanced in-room sensors, AI, and automated documentation capture to power virtual admission, virtual rounding and virtual discharge workflows.

A Comprehensive View into the Care Environment

care.ai™ Virtual Nursing is assisted by real-time, AI-powered autonomous inferencing. The care.ai™ Platform can automatically detect potential problems such as fall risks, providing an additional level of patient safety support.

Virtual Nursing features can be tailored to the specific needs and focus of your care team and organization.

A Second Nurse in the Care Suite

care.ai™ Virtual Nursing delivers a new and enhanced layer of support to care teams. Virtual Nurses can manage a wide variety of patient care tasks, from routine monitoring and documentation to education, precepting and compliance reporting. On-site nurses are then able to focus more time and attention on the crucial hands-on care that only they can provide. The results include improved clinical outcomes, higher patient satisfaction scores, greater staff retention and reduced operating costs.

The World’s Most Advanced Virtual Nursing Platform

• Small device footprint utilizing in-room TV
• On-demand two-way audio/video conferencing
• Activation via menu or voice
• Multi-stream video for family calls, care team consultation, language translation
• Automatic TV activation & switching
• Automatic call transcription

Insights

The care.ai Virtual Nursing solution includes powerful reporting and analytics tools that provide granular-level data on session parameters, protocol adherence and care team efficacy.

Use the IDA Command Center Performance module to view Virtual Nursing session data over any time range, from a per-Sensor level to across your entire organization. Know the number of sessions held, session duration, which rooms, which nurses, tasks completed and more.

Reporting data can be integrated with EMR and other applicable systems, and used for regulatory compliance, reimbursement support, and admin planning.

Clinicans