This article describes the different views seen in the Inovalon ONE Provider Platform and Claims Management Pro, as well as how to navigate in the system. Facilities and Entities management is also described in this article.
- Inovalon ONE Provider Platform: portal to access Claims Management Pro, Eligibility responses (outside of the Valant EHR - not recommended), Admin functions, and training resources.
- Claims Management Pro: access to enrollment creation and management, manage claims, Eligibility responses (outside of the Valant EHR - not recommended), and configure and view report data.
Inovalon ONE Provider Platform and Claims Management Pro Access
The designated business contact and authorized signer for insurance contracts at the practice will receive an email from Inovalon for access. A single Inovalon account per tax ID should be set up using the instructions and link from the email.
Inovalon Home Screen Navigation
Header
Practice ID field: Unique Inovalon-assigned number, and practice name
Training and Support tab: specific training shown under each section
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Front-end RCM Eligibility Workflow link: several video tutorials available, for full workflow information see the Eligibility Workflow User Guide document.
- Note: Eligibility checking outside of the Valant EHR is not recommended
- Back-end RCM Claims Management Pro link: several video tutorials available, for full workflow information see the Claims Management Pro and Enrollment User Guide document.
- Inovalon ONE Provider Platform link: applicable for Administrators
Configuration tab (available only for Administrators):
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User Name drop-down:
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My Links drop-down: The My Links dropdown box appears at the top of all Inovalon ONE Platform pages. Those links selected most often appear in the left column. Those links set up as favorites appear in the right column. Click Edit or the plus sign (+) to open the Manage Favorites dialog box to manage favorite links and the order for them to appear.
Top Tabs
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Front-end RCM: eligibility checks outside of the Valant EHR, additional set up required (not recommended) |
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Back-end RCM: link to managing and correcting claims in Inovalon through Claims Management Pro |
- Care Management – not available
- Tracking – not available
- Analytics – not available
- Workforce Management – not available
My Workspace widgets/boxes/tiles
- Front-end RCM Eligibility Workflow: alternate navigation to eligibility checks outside of the Valant EHR, additional set up required (not recommended)
- Back-end RCM Claims Management Pro: alternate link to managing and correcting claims in Inovalon through Claims Management Pro
Access Claims Management Pro
- click Launch Claims Management Pro from the Back-end RCM tab, OR
- click Claims Management Pro, then click Launch Claims Management Pro from the Back-end RCM widget/box under “My Workspace”
Claims Management Pro Home Screen
Upload Files button: DO NOT USE as files are uploaded through the integration with Valant
Upper Right Icon Bar
Messages Icon: Open the message inbox to send and receive messages between users within your organization. This is an encrypted messaging system so patient PHI can be included in the message contents. The red badge number indicates the number of inbox messages.
Alerts Icon: Messages that either have information, let you know a report is available to view and download, or may require you to take action. A red badge indicates the number of alerts. Alerts can be snoozed.
- Yellow - Informational text only.
- Green - Report available to view and download.
- Red - Alert that may require action.
Notices Icon: Notifications provide information about the account such as updates or improvements to the application. A red badge indicates unread notifications. Notices can be marked as read or unread, or may be deleted.
Top Tabs
- Home: navigation to the initial screen from anywhere in the system
- Dashboards: overview of claims which were transmitted through the Valant EHR. The Dashboards display all activity in need of attention before receiving a remittance. See section below for more Dashboards details.
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Admissions:
- ABN: (Advanced Beneficiary Notice) specific Medicare based application
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Eligibility
- Request
- Responses
- Batches
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Claims:
- Professional: navigation to full list of claims transmitted from the Valant EHR for processing to the payer
- Audit Management: assists Medicare practices with tracking audit information for ADRs (Additional Documentation Requests). For brief explanation, navigate to Inovalon ONE | Training & Support | Claims Management Pro | Product Essentials Training | More Articles… | Claims Management Pro: Product Essentials Training - Session 4
- Appeal Management: ability to create and track appeals sent for denied claims. For brief explanation, navigate to Inovalon ONE | Training & Support | Claims Management Pro | Product Essentials Training | More Articles… | Claims Management Pro: Product Essentials Training - Session 4
- Batches: lists all of the claim files transmitted from Create Insurance Claims in the Valant EHR grouped by practice designated filters
- Medicare Direct Files: not available
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Collections: displays remits
- Remit payment: displays remit as a whole
- Remit detail: displays claims associated with received remits
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Reporting:
- My Reports: reports that were generated
- Reports: pre-defined collection of reports to run
- Remit Analytics: available for an additional cost
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Settings
- My User Account: customization for alerts and claim related settings (General tab, Settings tab, Permissions Tab, Access tab, Email subscriptions tab, and PGP Encryption tab)
- Task Scheduler: create, edit, and delete of tasks as well as view details of individual tasks
- Users: edit of user information or lock/unlock user accounts
- Groups: collection of users that need to access certain modules, with the administrator assigning them permission to do so
- Profiles (Profiler): create, edit, or delete of filters used throughout the Inovalon system
- Entities: create, edit, or delete the facility or provider associated with the tax ID. See section below for more details on Entities.
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Payer:
- List: view, modify, manage payers from entire database of system payers with Inovalon
- Matches: allows mapping between two payers
- Match Dashboard: displays claim payers not matched to an Inovalon system payer
- Medicare Submitter ID Credentials: not available
- Enrollments: not available, Valant users will access enrollments through the “Inovalon Enrollment” link
- Inovalon Enrollment: create, view, manage enrollment contacts list
- Email Subscriptions: system notification when needing to take action on an audit or appeal
- eMDR Registration: not available
- Contract Management: recommend users manage Fee Schedules through the Valant EHR; Inovalon training resource if needed
- DDE Maps: not available
- Custom Fields: modify and describe claim based on a customized field name
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System (Administrators only)
- Medicare Policies: not applicable for Valant users
- HCPCS /CPT (R): provides detailed information related to these codes
- ICD-9: deactivated
- ICD-10: provides information for all ICD-10 codes
- Training: links to either the user guide pdf or the video training library
Quick Links (Tiles)
Note: Tiles available to the practice may differ from the image and list below
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Recommended to run eligibility through the Valant EHR, alternative processes for eligibility available through the below quick links. Responses shown for requests submitted through Claims Management Pro (not recommended)
ABN: (Advanced Beneficiary Notice) specific Medicare based application Professional Claims: 837 electronic file (equivalent to HCFA 1500) Claim Batches: all of the claim files transmitted from Create Insurance Claims in the Valant EHR grouped by practice designated filters Audit Management: assists Medicare practices with tracking audit information for ADRs (Additional Documentation Requests) Appeal Management: ability to create and track appeals sent for denied claims Remit Payments: displays remit as a whole Remit Details: displays claims associated with received remits Remit Analytics: specific reports for remit data – available for additional cost (contact subscription services to add) Payer Match (Dashboard): link to the pending claims that require a payer match due to an incorrect payer ID File Manager: not necessary Reports Payer List: view, modify, manage payers from entire database of system payers with Inovalon |
Dashboards Overview
Navigate to Inovalon | Back-end RCM Claims Management Pro | Dashboards tab
Each tab provides detail on actions needed to submit claims. When action is needed, a link is shown that, when clicked, navigates the user to the location which needs the action completed.
Entities Creation and Management (administrators only)
Navigate to Inovalon | Back-end RCM Claims Management Pro | Settings tab | Entities (facilities where services are provided)
Add individual entities by clicking New Entity, or add several entities by clicking Import Entity. Required fields are indicated by a red asterisk.
Entity Properties: populate required fields (marked with a red asterisk)
- Type: select “Facility/Group” or “Physician” based on Tax ID registration
Entity Identification: allows population of all associated ID numbers assigned to the facility
- Click Add ID, select Type from drop-down options, enter corresponding ID number in “Value” field, optionally add a “Label”
- Click Save in “Tools” on the right side of the screen
Enrollment Contacts:
- Primary Communication Contact: practice office contact for all payer enrollment communication
- Default Authorized Enrollment Signer: primary practice office contact for signature requirements
- Secondary Communication Contacts (optional): practice office contact for enrollment questions once submitted to the payer
- Additional Authorized Signers (optional): practice office contact for signature requirements if primary signer is unavailable
To manage entities, select Edit from the Action drop-down options, update the desired information, click Save
Notes:
- Shared Tax IDs can’t be registered for ERAs unless specific parameters are met
- NPI and Tax ID can only be enrolled once with the clearinghouse