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Not all Payers require enrollment to submit claims. Inovalon maintains a list of Payer IDs that require enrollment or not which you can find here : https://www.inovalon.com/payer-list/#tab-1713242307909-0When you click this link, you’ll see three tabs. Be sure you’re on the first tab ( Claims Management Pro Payer List) as shown in the image belowportal:
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In the rightmost column of this Payer ID list, you’ll see “Enrollment Required (Y/N)”. This indicator tells us which Payers require you to enroll with them before you submit your claims to them.
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If you previously used Change Healthcare and are transitioning to Inovalon, you will need to review your Payer IDs set within MacPractice to ensure they match Inovalon’s Payer ID list. If you do not do this, you may experience claim rejections due to incorrect Payer ID. You’ll need to set You can update Payer IDs by navigating to your Insurance Company References |
Setting up Entities
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References in the References Ability, and select each Insurance, and update the Payer IDs to match Inovalon’s list. Below is a screenshot of the exact field you’ll want to update. While you’re in here, you will also want to ensure that there are no special characters in the Insurance Company name. (No parentheses or other symbols, just alphanumerical characters)  |
Setting up Entities
First, you’ll need to set up your Entities to confirm that they are correct. These refer to your Billing Entities, the Facilities and Physicians that you will be billing under.
You can access Entities from the Claims Management Pro dashboard > Settings > Entities.
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The Entity table contains records for all of your billing offices and physicians, and Inovalon will pull this information when submitting claims to a specific payer. This information will also be used when enrolling for these payers (that process is discussed later in the article)
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By default, you should see your office’s primary facility in this list when you first visit the Entities table. You will need to double check the information in this default Entity by clicking the Edit button in the Action column.
Furthermore, we’ll need to add an Entity for all your billing offices and providers by clicking the “New Entity” button.
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One of the unique quirks we’ve discovered in Inovalon’s Payer Enrollment process is that we’ve had more success with Providers that need to bill as an individual by adding them into the Entities table as a Facility. By doing this, we ensure that when claims are submitted to payers, that Claims Management Pro pulls the appropriate NPIs. |
Every enrollment Payer Enrollment requires a Facility Entity on this table to complete the enrollment, and providers billing as individuals will need to be registered as a Facility in this list.
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Things you need to make sure of :when adding and checking your Entities
9 digit zip code (no hyphen in the zip code) for each Entity
Demographic information is correct for each Entity listed.You’ll need to make sure
Entity Identifications
All billing Entities MUST have the following
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IDs
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added by clicking the “Add ID” button under the Entity Identification section shown in the image above.
Required Entity IDs for Enrollment:
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If you find yourself in the situation where you have failed enrollments, we first recommend that you revisit the Entity Table in the prior section (Insert link here) to confirm that your Entities are configured properly and all data is entered as expected before proceeding with these steps.
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Separate from Claims Management Pro, the Inovalon Enrollment Portal is used to manage Payer requirements for enrollment. This is where you’ll provide signatures and fill out forms for each Payer ID’s needs. You The Primary Contact on the Inovalon account will have been sent an email with a link to complete your account set up on this portal.
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In this tab, we can approve, reject or cancel enrollments based on the information received from the email the Payer sent.
Orange exclamation marks (
) indicate that an enrollment is SPP (Status by Partner or Provider only). This means that the user will need to indicate where the status of this payer enrollment based on the email provided.To act on an enrollment, click on the To act on an enrollment, click on the pencil icon in the Actions column. You’ll then be able to Approve,
Reject, change the follow up date, or cancel the enrollment. You’ll also see follow up notes, and the contact information here.
Do note that some enrollments will have alert triangles in the Actions column:
Yellow Alerts (
), Orange Alerts, and Red Alerts (
) indicate that this enrollment is approaching 15 days. At 15 days, Inovalon will cease following up with providers on enrollments. When you see these alerts, that means you should follow up on any outstanding tasks for this enrollment.At 45 days with no action, any pending enrollments will be cancelled and will have to be restarted.
Canceling an enrollment here will only cancel the enrollment within Enrollment Portal. At this point in the process, the enrollment has already been sent to the payer, and we cannot stop it from processing on the payer’s end.
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