Inovalon Payer Enrollment Guide
- Dylan Nigh
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.
- 1 Logging on for the first time
- 2 What Payers Do I Have to Enroll With?
- 3 Setting up Entities
- 4 Enrollment Process in Claims Management Pro
- 5 Enrollment Status Message Meanings
- 6 Inovalon Enrollment Portal
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/
After signing in with your set credentials, you’ll need 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 this link to take you to the Claims Management Pro portal dashboard.
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 on the Claims Management Pro portal:
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.
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 can update Payer IDs by navigating to your Insurance Company 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.
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)
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.
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 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.
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.
Entity Identifications
All billing Entities MUST have the following IDs added by clicking the “Add ID” button under the Entity Identification section shown in the image above.
Required Entity IDs for Enrollment:
EIN
NPI
These Entity IDs are only required if they bill to a payer that uses these:
Medicaid Number
Medicare Number (PTAN)
Medicare Railroad
Blue Cross Blue Shield
Entity Enrollment Contacts
Each Entity MUST HAVE a Primary Communication Contact and a Default Authorized Enrollment Signer set. You can select these by using the link buttons in the field or by adding them with the Green Plus button to the right of the entry fields.
Once you have confirmed all of your billing offices and providers have been added to the Entity table as Facilities, and each Entity has all required fields and all necessary Entity IDs, you can proceed to enroll for payers.
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.
You will need to use Add Facility for BOTH Facilities and providers billing individually. You will not use the Add Physicians Button here.
When you click Add Facilities, this will bring up the Entity table that you reviewed in the prior step. The list of available entity records matching either the Entities listed within your Inovalon Claims Management account will display as selections to enroll.
You have the option to select multiple Entities 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.
Make sure to check at the bottom of this window and use the page toggle buttons to review all searched results, in case you don’t find the payer you’re looking for on the first page!
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.
If you are unsure whether to enroll for Institutional or Professional when presented the option, typically Institutional claims would be submitted using a UB-04 claim form equivalent, and Professional would be submitted using a CMS-1500 form equivalent.
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.
You may also see a “Duplicate” Validation Status in here. To get information on why this has been flagged a duplicate enrollment request, click the blue “I” in the Action Column for additional information. You may be prompted to verify previous entry, and you may be prompted to confirm whether to resubmit.
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
Note:
After revalidation and the enrollment request has “passed,” the record will reflect a green PASSED icon on the enrollment in the Validation Status column.
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.
After entering in Payer Enrollments, you can check the general status of Payer Enrollments here on Claims Management Pro, but any additional requirements or needs will need to be met on Inovalon’s Enrollment Portal (affectionately referred to as the Purple Portal)
For more information on the Enrollment Portal, click here.
Failed Enrollments
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 to confirm that your Entities are configured properly and all data is entered as expected before proceeding with these steps.
Navigate to the View Status screen.
Settings > Inovalon Enrollment > View Status
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.
The Enrollment Request Detail dialogue box will populate. Choose the Restart button in the bottom right-hand corner to restart this enrollment.
If you do not have a Restart button, you will need to remove the Enrollment Request and create a new one. You can use the Red “X” button on the Enrollments Request table to remove an Enrollment. You may be required to provide a reason for cancelling the enrollment request.
This will not remove it from the table, but those requests will have a Cancelled status.
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.
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.
In this screen, you will now click the Yes, Submit All button to allow this enrollment to be restarted.
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
Navigate to the Inovalon Enrollment View Status Screen.
Settings -> Inovalon Enrollment → View Status
Note: Any enrollments for any accounts you have selected on your Account Selection Screen in the upper right will populate when you open the Enrollment View Status grid. You are still able to filter out the data you wish to see by using the Profiler or the Quick Search Option on the grid.
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.
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).
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.
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.
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.
Status | Status Description | Activity (Latest) | Next Step Owner | Next Step |
|---|---|---|---|---|
FAILED | Failed to Initiate Enrollment Process | (None) | Customer | Verify Entity Table information and restart enrollment |
On Hold | ERA Enrollment on hold | (None) | Customer | Claims for the ERA payer must be submitted through Claims Management before ERA Enrollment will release for enrollment task creation. |
SCHEDULED | Scheduled for Processing | (None) | Automatic Process | Enrollment task will be created and sent to Enrollment Contact in Entity Table for completion, if required. |
PENDING PROVIDER | In Progress | Task or Signature Request Sent to Provider OR Inovalon reached out to Provider for Follow- up. | Customer | Complete paperwork/instructions sent by Enrollment Team. |
PENDING PAYER | In Progress | Request/Form Sent to Payer | Inovalon Enrollment | Enrollment team to track progress with the Payer. |
APPROVED | Successfully Completed | Request Approved by Payer OR Request Auto- Approved Without Payer Confirmation | NONE | NONE |
REJECTED | Request Rejected by Payer | Request Rejected by Payer. Reason: | Customer | Review rejection. Correct any missing/invalid data and re-enroll. If you do not wish to re-enroll, ignore rejection. |
CANCELLED | Cancelled | Canceled by: (Varies) Reason: (Varies) | Customer | Confirm if enrollment needs to be restarted or truly not needed due to wrong plan, wrong transaction type, etc. |
Inovalon Enrollment Portal
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. 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.
Logging into the Enrollment Portal
Open your web browser and navigate to: https://inovalon-enrollportal.madakethealth.com/login
Your email address is your login and enter in the password you created from the registration link sent to your email. These are not the same credentials as the Claims Management Pro portal.
NOTE: If you have never logged into the Inovalon Enrollment Portal, review your email for a Welcome email with a link to setup your password.
If you have forgotten your password, please click “Forgot Password” and enter your email address so an updated link can be emailed to you.
General Portal Navigation
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.
We recommend that you look at the Open Enrollments section on the right hand side of the Enrollment Portal dashboard, specifically, the Provider Open Tasks link under Open Enrollments.
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.
Provider Open Tasks
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.
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
You’ll note on the left hand side of this table are Tasks that need to be completed. These Tasks can be clicked on to take you to where you can complete the step indicated (For example, clicking “Complete Digital Signature” in the example below will take you to where you can complete that signature)
Let’s discuss how to complete these tasks when you click on them!
Task - Complete Digital Signature
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.
Click the Add/edit signature button.
Enter in the Signature Name, Signature Title and select the font you wish to use OR select Sign by Hand.
A Signature Title IS REQUIRED! (Examples would be Provider, Doctor, etc.)
Once completed, click Confirm.
The person signing the form must be authorized to do so to avoid rejections from the payer.
You are required to open and review the document before you can move forward. You may be prompted to validate information and click or select items to verify them in subsequent prompts. Here is one example of such a prompt:
In this example, you’ll see the radio buttons on the right hand side for Trustmark and AARP. In this situation, you would need to review both documents before you can select an option for EACH Payer in order to proceed.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 Inovalon to review. Once the issue is corrected, the task will appear back in your work queue for completion.
Task - Online Payer Portal Enrollment
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.
Start by clicking the Enrollment document button to download the instructions.
Navigate to the appropriate website/portal and complete the steps.
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.
Note: If you notice an error on the form, choose Report Form Problem. This will cancel the enrollment and create a ticket for Inovalon to review. Once the issue is corrected, a task will appear back in your work queue for completion.
For Medicare, once you complete Medicare’s Enrollment Portal process, you will receive a Packet ID, which will need to be entered in an extra field during this step. This Packet ID is REQUIRED to complete enrollment with Medicare.
Task - 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.
Note: It is important that you follow these instructions carefully. Some mailed forms will need to be signed and sent by mail. The instructions will notify you where the forms need to be mailed.
Enrollments Section
On the top banner of the Inovalon Enrollment Portal, you’ll see a link to the right of the Dashboard link for “Enrollments”.
This Enrollments section is where you view, track and manage your enrollments. 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’
Generation In Progress - This tab indicates enrollments that are currently being processed by the system and no current action is required by you.
Payer Processing - This 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.
Ready for Status - This tab includes enrollments that have made it through the defined Payer Processing time and are ready for payer outreach for final status.
Completed - This tab contains all completed enrollments.
Ready for Status Enrollments Tab
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.
Enrollments present in this tab will have additional information sent from the Payer to your contact email with either a confirmation or with additional steps required.
Please be on the lookout for this email from the Payer.
In this tab, we can approve, reject or cancel enrollments based on the information received from the email the Payer sent.
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.
Generation in Progress Tab
The Generation in Progress tab contains enrollments that are currently being processed by Inovalon. No action is required by the user at this point in the enrollment process. Enrollments are shown in order of start date.
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.
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.
Approved – Enrollment has been approved by the payer.
Rejected – Enrollment has been rejected by the payer.
Canceled – Enrollment has been canceled due to it no longer being needed.
Note: If an enrollment was rejected, you will see notes that show the reason for the rejection. The necessary adjustments will need to be made before enrollment can be resubmitted.
Exporting Enrollment Data
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.
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.
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.
Click the Next button to include all rows on your profiler.
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.
