This article covers the process of how to enroll for your payers on Inovalon’s portal (Claims Management Pro). The information in this article is derived from this PDF provided by Inovalon:

The instructions provided in this article are intended for when you have received an email from Inovalon with a link to set up an account on Claims Management Pro. If you have not received your email, you can refer to our Inovalon Onboarding Guide article here for more information.

When you begin Payer Enrollments for the first time, you’ll be sent an email to a new Inovalon Enrollment Portal to be used to track Payer IDs. This is the Inovalon Enrollment Portal mentioned in the second half of this article.

Logging on for the first time

When you first log on to the Claims Management Pro portal after setting up your account, you’ll find yourself on the front page of the Inovalon One Portal. You can also visit this site via the following URL:

https://providercloud.inovalon.com/

First, you’ll want to click the “Claims Management Pro” tab underneath “Back-end RCM” as shown in the screenshot below. This will reveal a link to “Launch Claims Management Pro. Click that.

When launching Claims Management Pro for the first time, you’ll probably see this alert containing legal notices about the usage of CPT. Feel free to peruse and click “I Accept” whenever you are ready.

What Payers Do I Have to Enroll With?

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-1713242307909-0

When 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 below:

If you scroll down, you’ll see a preview of the PDF that contains the Payer List. 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.

Mass Enrollment Process in Claims Management Pro

We’ll first want to navigate to the Settings Menu and select “Inovalon Enrollment > Create”.

This will bring you to the Enrollment Requests page. In the upper right hand corner above the table, you can see a “Create New Request” button, as shown in the image below. Click this button.

From here, you can either enroll facilities/physicians, or payers. For our purposes, we’ll pick “Facilities / Physicians”.

Adding Facilities and Physicians

When you choose the Facilities/Physicians button, you will be taken to the screen to add your facilities or physicians for enrollment. In the upper right-hand corner, you will notice two buttons to add the pertinent enrollment information.

• To add Facilities: Click the Add Facilities button.

• To add Physicians: Click the Add Physicians button.

When selecting either of the options above, a new search and selection box appears. In this box, the list of available entity records matching either the Facility or Physicians listed within your Inovalon Claims Management account will display as selections to enroll.

You have the option to select multiple facilities or physicians from this list, which allows you to create multiple enrollment requests simultaneously. To select a facility/physician, click the checkbox next to the entities you wish to enroll and click Apply in the bottom right-hand corner of the screen. After adding all the facilities/physicians you need to enroll, click the Continue button in the bottom right-hand side of your enrollments screen as shown below.

Adding Payers to Enroll To

You will now be moved to the Payer Selection screen.

Click the Add Payers button in the upper right-hand corner of the Payer Selection Screen. The Add Payers selection box will now display.

You can search this screen by Payer ID, Payer Name, or Claim Indicator Code.

• You have the option to select multiple payers from this list, which allows you to create

  multiple enrollment requests simultaneously.

• To select a payer, click the checkbox next to the payer you wish to enroll and click Apply in

  the bottom right-hand corner of the screen.
  

  

  
  

• After adding all the Payers you need to enroll, you will now see that your payers are listed in the Add Payers screen. From here select the transaction types for which your facilities/physicians need to enroll. Do this by simply clicking the checkboxes located under the Transaction type columns you wish to enroll.
  

  

• You will notice that some enrollments have multiple checkboxes available, while others have “-“ or N/A.

  • Transactions that have a “-“ do not require enrollment and are available for you to leverage immediately.

  • Transactions that have a N/A are not currently available in the Inovalon Claims Management system.

• Once you’ve selected your transaction types for each payer, click the Review button in the bottom right-hand corner.
  

The Review screen will display the current status of your request.

• This screen will show the Payers selected, Account Names, Entity Names, NPIs, EINs and

  Transaction types for the enrollments you are requesting. A Validation Success column shows whether these enrollment requests can be completed currently. PASSED means this enrollment request is ready to submit through the automated enrollment process. FAILED means there is an issue with the requested enrollment.

• To further understand why this enrollment request has failed, click on the blue “I” in the Action column.
  

  

The Enrollment Data Validation Failed dialogue box displays with reasons why your enrollment request cannot be processed. An example in the screenshot below shows that this entity table reflects missing information: Entity identification number of type Medicare Number is required.

• To correct this error, click the blue text which takes you to your entity table configuration for

  the failed enrollment’s entity record. You will then update the information as appropriate,

  based on the information in the previous dialogue box and click Save.

• Once this has been completed, you will then migrate back to the Enrollment Data

  Validation Failed screen and click the Revalidate button

• If you decide not to move forward with this enrollment, you can click the Cancel button on the bottom left hand corner this screen.

Once you have created your enrollment requests and all have “passed” validation, you can now click the Submit button in the bottom right-hand corner of your screen.

• Your enrollment requests have now been submitted and appropriate instructions will be emailed to you within 24 hours.

Cancelling Pending Enrollments

If you find yourself in the situation where you need to cancel any pending enrollments, you can follow these steps:

1. Navigate to the View Status screen.

   • Settings > Inovalon Enrollment > View Status

2. Navigate to the enrollment you wish to Restart via the Profiler or the Quick Search options at the top of the Enrollment Status screen. To restart an enrollment, simply click Magnifying Glass icon located in the Action column on the Enrollment Request grid.
   

   

3. The Enrollment Request Detail dialogue box will populate. Choose the Restart button in the bottom right-hand corner to restart this enrollment.
   

   

4. You will then be redirected to the Create Enrollment Request screen and will click the Review button in the bottom right-hand corner of the Facility selection screen.
   

   

5. You will now notice that the Validation Status reflects a “Duplicate” status. Click on the blue “i” icon in the Action column on the right and the Enrollment confirmation dialogue box populates.

6. In this screen, you will now click the Yes, Submit All button to allow this enrollment to be restarted.

7. The Validation Status will now update to Passed and you can select the Submit button in the bottom right-hand corner of your screen to successfully transmit your new enrollment request.

Checking Status of Enrollments

1. Navigate to the Inovalon Enrollment View Status Screen.

   • Settings -> Inovalon Enrollment → View Status

2. There are two ways to sort and filter your Enrollment information.

• Option 1: Choose the Quick Search button at the upper left-hand side of the Enrollment Requests grid.

  • You can then filter by Payer Name, Status, EIN (Tax ID), or NPI by filling out the appropriate information and clicking the Search button.
    

    

• Option 2: Click the Profiler button to filter with more detailed data. Click Apply in the upper right corner once you have finished choosing your filter options

  • Example: Created Date, Transaction Type, Status, Provider, Payer, etc.
    

    

3. Your Enrollment Requests grid also has the option to populate multiple columns of information for each individual enrollment request (If you find you need a new column, you can click the Update Columns button and choose other data columns you wish to display in the default view).
   

   

4. The Select Columns dialog box will open. You can then click the available checkboxes to add or remove any data you would like to view on your enrollment view status grid. You can also reorder the columns by clicking the selections on the left and moving them to the order you would like to see them. Once completed, you can click Save and your grid view will be updated.
   

   

5. Once you have filtered your enrollment requests and have your columns view set to your preferences, you can now view additional detail for each enrollment, if necessary.

   • To View an individual enrollment request’s history, you can choose the Magnifying Glass icon in the action column.
     

     

6. Once selected, an Enrollment Request dialog box appears with historical and current status information for the enrollment.

   

Enrollment Status Message Meanings

Based upon the status of your enrollment request, you should be able to discern next steps, if any, on how to complete your enrollment or view its current state.

Inovalon Enrollment Portal

Separate from Claims Management Pro, the Enrollment Portal is used to track your enrollments with the various payer IDs from the prior section.

Logging into the Enrollment Portal

1. Open your web browser and navigate to: https://inovalon-enrollportal.madakethealth.com/login
   

   

2. Your email address is your login and enter in the password you created.

General Portal Navigation

Dashboard - Daily Digest

1. Upon logging into the Inovalon Enrollment Portal, you default to the Enrollment Dashboard. On this screen, you can see your Daily Digest. The Daily Digest visually outlines how many new tasks you have requested, how many enrollments requiring Provider outreach are ready for status, and how many new approvals and rejections have processed from the previous day. The Dashboard defaults your view to include all accounts you have access to. For most users this will be a single account.
   

   

2. For those users who have access to multiple accounts or providers, you can use the purple filter icon located in the upper left side of the dashboard to drill down into those specific accounts. You can search here by name, Site ID, NPI or TIN. Once you have placed a filter on the data and clicked “Search”, this filter will be maintained as you navigate to the different areas of the Enrollment Portal.
   

   

Open Tasks

1. The Open Tasks Section aggregates all your pending provider tasks into an easy to navigate list. These requests populate based on the enrollment requests you made within your Inovalon Claims Management system and provide the assigned workflows and steps required by the individual payers to successfully enroll.

2. Any enrollments that require provider action will be listed in the Open Tasks section. You’ll notice each task is specific to the payer, transaction type and NPI/Tax ID requested. From this view, you will be able to review each enrollment task to complete digital signatures, review payer portal instructions, and download forms that require physical signatures.

Enrollment Task Types

Digital Signature

1. Some payers allow for their enrollment paperwork to be signed electronically. If you have chosen an enrollment that requires a digital signature, please follow the step-by-step directions on their screen.

   1. Click the Add/edit signature button.

   2. Enter in the Signature Name, Signature Title and select the font you wish to use OR select Sign by Hand.

2. Once completed, click Confirm.
   

   

3. The person signing the form must be authorized to do so to avoid rejections from the payer.

   1. You are required to open and review the document before you can move forward.

   2. If the document contains an error, you will receive a text box where you will further describe the issue. This will cancel the enrollment and create a ticket for Madaket Health to review. Once the issue is corrected, the task will appear back in your work queue for completion.

Complete Next Steps - Online Payer Portal Enrollment

b. Some payers require you to complete enrollment steps on their dedicated system. If you chose one of these payers, you will be prompted to follow the step-by-step instructions on your screen.

c. Start by clicking the Enrollment document button to download the instructions.

d. Navigate to the appropriate website/portal and complete the steps.

e. Once you have completed the enrollment process on the payer’s portal, navigate back to this enrollment record and click the green “Submit” button.

You are required to open and review the document before you can submit the request.

f. Notes:

i. If you notice an error on the form, choose Report Form Problem. This will cancel the enrollment and create a ticket for Madaket to review. Once the issue is corrected, a task will appear back in your work queue for completion.

ii. You will also have the option to enter a Packet ID if supplied by the payer.

2. Upload Enrollment Form - Physical Signature May Be Required
   

   

Some payers require their enrollment forms to have a physical signature. These tasks look like online enrollments, but the PDF may require you to download, print, sign and upload the form back into the system.

You are required to open and review the document before you can submit the request.

Enrollments Section

Enrollments is where you view, track and manage your enrollments. In order to access Enrollments, you’ll need to click on the Enrollments button on the top banner of the screen. By default you’ll be able to see all of the data you have access to. In Enrollments, there are four tabs, ‘Generation in Progress’, ‘Payer Processing’, ‘Ready for Status’, & ‘Completed’

1. Generation In Progress, meaning enrollments that are currently being processed by the system and no current action is required by you;

2. Payer Processing tab shows any enrollments that have been submitted to the payer, but that have not reached their estimated processing time and are still under review.

3. Ready for Status which include enrollments that have made it through the defined Payer Processing time and are ready for payer outreach for final status;

Ready for Status Enrollments Tab

1. When you enter the Enrollments section, you will land on the Ready for Status Enrollments tab by default. The enrollments shown here have passed their estimated processing time with the payer and are ready for follow up.
   

   

2. Self-service functionality in the Ready for Status Enrollments tab allows you, the user, to approve, reject or cancel enrollments based on information you receive from the payer.

3. Orange exclamation marks ( ) indicate that an enrollment is SPP (Status by Partner or Provider only).

4. 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.
   

   

5. 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.
   

   

Payer Processing Enrollments Tab

The Payer Processing Enrollments tab shows any enrollments that have been submitted to the payer, but that have not reached their estimated processing time and are still being reviewed by the payer. Enrollments are listed in order of estimated completion date, from oldest to newest. You can act on enrollments in the Payer Processing tab by clicking on the pencil icon in the Actions column.

Generation in Progress Tab

The Generation in Progress tab contains enrollments that are currently being processed by Madaket. No action is required by the user at this point in the enrollment process. Enrollments are shown in order of start date.

Completed Enrollments Tab

The Completed Enrollments tab contains enrollments that have been completed or closed. Enrollments are listed in order of completion date, with more recently completed enrollments listed first.

1. Approved – Enrollment has been approved by the payer.

2. Rejected – Enrollment has been rejected by the payer.

3. Canceled – Enrollment has been canceled due to it no longer being needed.

Exporting Enrollment Data

1. Within Inovalon Claims Management → Settings → Inovalon Enrollment → View Status screen, you have the option to do a full export of your profiled data into a CSV file, which you can import into Microsoft Excel. To do this, you will choose the Export Wizard button in the upper right-hand area of the screen.
   

   

2. When you choose the Export Wizard button, a separate dialog box pops up to walk you through the export process. You can choose either a CSV or PDF format for this export.
   

   

3. After choosing a file type, select the data you wish to export from the available section by clicking the checkboxes. You can also reorder the columns in your report by changing the order of the data fields on the left under the Selected section. Once you are comfortable with the data being exported, click the Next button.
   

   

4. Click the Next button to include all rows on your profiler.

   

5. You can create a custom name for your report or leave it as the defaulted Filename. Once completed, click the Next button. Your report is now being generated and will be created as a downloaded file from your Inovalon Claims Management system. You can now review the CSV or PDF file.