This article serves as a guide for how to review your submitted claims on Inovalon’s Claims Management Pro portal, which you can access here: providercloud.inovalon.com. This guide assumes you have completed the Inovalon Onboarding process and have been set up with access for Claims Management Pro.

If you haven’t already followed the steps in the Inovalon Payer Enrollment Guide to enroll for the payers that do require it, and verified that you’ve updated Payer IDs in MacPractice, we strongly urge you to review that guide thoroughly. This can curtail many claim rejections and errors.

1 Inovalon Help Resources
2 Adding and Managing Users for Claims Management Pro
3 Sending and Rebuilding Claims
4 Locating your Claims on Claims Management Pro
- 4.1 How long does it take for claims to appear on Inovalon after sending them?
5 Viewing Claim Statuses
- 5.1 Institutional and Professional Claim Statuses
6 Remit Payments and Remit Details
7 Creating Timely Filing Appeal Letters in CMP

Inovalon Help Resources

Inovalon has a host of resources available to aid with understanding their process. You can find these options in CMP under the “Training” Menu.

The Inovalon User Guide is an excellent resource to understand individual areas of the Inovalon CMP interface. We strongly encourage you to download a copy of this.
- Up to date copies can be found under the “User Guide” selection in the Training Menu.
The Interactive Training section provides links to several valuable resources, but in particular we’d like to point you at the “QuickStart Live” series, which covers all the basic areas that a regular user would want to be aware of. Much of the advice listed here in this article has been pulled from these resources.
QuickStart LIVE series (Need to be logged into CMP to access these links)
- Quickstart Live: Reviewing Submitted Claims - https://providercloud.inovalon.com/supportsite/help/pages/claims-management-reviewing-submitted-claims-quickstart-live-0
- Quickstart Live: Working Errors on CMS-1500 claims - https://providercloud.inovalon.com/supportsite/help/pages/claims-management-working-errors-on-cms-1500-claims-quickstart-live-0

Adding and Managing Users for Claims Management Pro

Click the following link to find a dedicated article on how to add and manage users for your office in the Claims Management Pro portal:Inovalon - How to Add and Manage Users on Claims Management Pro

Sending and Rebuilding Claims

Once you have created your claims in MacPractice’s Ledger as described in eClaims - Creating an Electronic Claim, you can navigate to the eClaims Ability. You can send any claim that’s in the Ready bin in the eClaims Ability by clicking on the Ready tab, selecting the claims you want to send in the claims table, and then clicking the “Send” button:

In some cases when troubleshooting claim rejections, after making any corrections to the charges associated with a claim, you can use the “Rebuild” button to re-create claims for re-submission.

Click here to learn more about the eClaims Ability in general: eClaims Ability - Overview

Locating your Claims on Claims Management Pro

To find your Claims on the CMP Portal, you’ll look for the Claims Menu:

From here, you can find your Institutional and Professional claims, and you can also review specific batches of claims in the Batches selection. A batch is created whenever you click the Send button, and will contain the claims that you selected when you sent them.

How long does it take for claims to appear on Inovalon after sending them?

If your claim batch does not appear on CMP, it can take up to a few hours for batches to appear depending on Inovalon’s load at the time. You can verify that the file upload from MacPractice was received by navigating to the System Menu > File Manager when logged into CMP.

Once you’re in the File Manager, you’ll open the following folders and see if there are any files in the Import folder:

Partners > Mac####### > Imports

Viewing Claim Statuses

Institutional and Professional Claim Statuses

This table is from pg. 137 of the Inovalon User Guide:

Status	Short Description	Long Description

Status	Short Description	Long Description
ACK_DENIED	Denied Manually	This transaction was denied manually by a user.
ACK_FINAL	Acknowledged by Payer	Final acknowledgment has been received from payer.
ACK_MANUAL	Acknowledged Manually	The transaction was acknowledged manually by a user.
ARCHIVED	Archived	The transaction has been archived.
CREATED	Created	The transaction has been created.
CROSSOVER	Crossover Claim	The secondary claim was forwarded from the previous payer.
DELETED	Deleted	The transaction has been deleted.
DENIED	Denied	The payer has denied the transaction on a remittance advice.
DDE ERROR	DDE Error	The Medicare claim is in error status. (Institutional Claims Only)
DDE PROCESSING	DDE Processing	The claim is currently locked for processing via Medicare FISS/DDE and cannot be modified. Click “Workflow” to view claim details. (Institutional Claims Only)
ERROR	Validation Failed	The transaction has errors that must be corrected before it can be released and sent to the payer.
FOLLOW-UP	Follow-up	The transaction has been marked for follow-up.
HOLD	Hold	The transaction has been put on hold.
INFO	Informational	The transaction is informational only and will not be processed.
MCARE_ADR	Medicare ADR	Medicare has requested ADR for this claim. (Institutional Claims Only)
MCARE_REJ	Medicare Reject	Medicare has rejected the claim in the DDE system. (Institutional Claims Only)
MODIFIED	Modified	The transaction has been modified.
PAID	Paid	The Payer has paid the transaction. View remittance for additional information.
PRINTED	Printed	The transaction was printed.
PROCESSING	Processing	The transaction has been locked by the clearinghouse for processing.
QUEUED	Queued For Transmission	The transaction has been queued for transmission to the payer. “Claim Transmissions to Payers and Batch Schedule” on page 220. Once claims are batches, they are submitted to the payer.
REJ_HOST	Rejected By Host	Clearinghouse has rejected the transaction.
REJ_MANUAL	Rejected Manually	Claim was rejected manually by the user.
REJ_PAYER	Rejected By Payer	The payer has rejected the transaction.
RELEASED	Released	The transaction is ready to be processed by the clearinghouse. Note: If the claim is to be printed onsite it will stay in released status until printed.
TRANSMIT	Sent To Payer	The transaction has been sent to the payer.
UNDELETED	Undeleted	The transaction has been undeleted.
UNHOLD	Released Hold	The transaction hold has been removed.
UNINFO	Removed Informational Status	The transaction informational only status has been removed.
UNKNOWN	Unknown	Transaction status is in an unknown state.
VALIDATED	Validation Success	The transaction has been validated.

Remit Payments and Remit Details

In the Collections Menu, under Remit Payments and Remit Details, you can find your EOBs and ERAs.

Creating Timely Filing Appeal Letters in CMP

You can learn how to create Timely Filing Appeals here:

Inovalon - Creating and Managing Timely Filing Appeals in Claims Management Pro