This article describes how to set up and manage payer enrollments in Inovalon.
Enrollment Set Up
As a part of Inovalon Payer Enrollments, the practice will need to fill out an Inovalon Payer List Spreadsheet received by the practice from the Implementation Team (downloadable document) with a full list of contracted payers for claims transmission and remittance received. There are two tabs in the worksheet.
The following columns need to be populated on the Payers tab:
- Payer Name: enter name as it is in the payer list within Valant
- Payer ID: navigate to the Inovalon Payer ID list
- NPI: the registered NPI that is contracted with the Payer
- Tax ID: the registered Tax ID that is contracted with the Payer
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Select Applicable Transaction Types Needed: identify for each payer which transaction type needs to be enrolled.
- Institutional Claims UB-04: transmission of institutional claims is not offered through Valant EHR
- Professional Claims CMS 1500: ‘Yes’ or ‘No’. If ‘Yes’, enrollment will be initiated; if ‘No’, enrollment will NOT be initiated
- Remits 835: ‘Yes’ or ‘No’. If ‘Yes’, enrollment will be initiated; if ‘No’, enrollment will NOT be initiated
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Remits: identify for each payer which remits need to be enrolled.
- Tax ID shared with another facility: ‘Yes’ or ‘No’. If ‘Yes’, bring to attention of enrollment specialist
- Note: If the practice’s/provider’s Tax ID is shared with a larger company/organization and ERAs are enrolled with another clearinghouse, they may not be able to enroll with Inovalon. This is typically described as 'splitting the ERA' or parsing the file and Inovalon is not configured for that to occur. As a result, be sure to list "no" in any column you wish to be excluded from the Enrollment process.
On the second tab, Provider ID Numbers, ensure the unique identifiers for specific payers are documented. During the enrollment process, those ID numbers will populate into the designated enrollment documents that are sent to the payer for approval. Enter as many unique identifiers based on Tax ID, NPI, or individual provider as possible.
Enrollment Management in Inovalon
Navigate to Inovalon | Claims Management Pro | Settings | Inovalon Enrollment | View Status
- Create Enrollment: begins a new payer enrollment request
- Enrollment Actions: Close, Restart, or Cancel the selected enrollment request
- Reload Grid: refreshes the view
- Update Columns: allows user to add or remove displayed columns
- Export Wizard: creates csv or pdf file of the existing enrollment requests
Enrollment Portal: separate website used by authorized signers identified in the entity table
- Enrollment Portal Access: email sent with registration instructions
- Enrollment Portal Tasks: final steps to submit enrollment paperwork completed in the enrollment portal
- See training videos below and the Inovalon Enrollment Portal User Guide
Note: Email notifications regarding the Enrollment Portal are time-sensitive and should be addressed quickly
Enrollments Training Videos in Inovalon
Navigate to Inovalon | Claims Management Pro | Training | Interactive Training
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Recommended Watch Order:
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