Inovalon Expands Revenue Cycle Data Analytics Software to Support All EDI Clearinghouses for Healthcare Providers

SaaS Solution Delivers up to 93% First-Pass Yield and Prevents Revenue Leakage While Improving Cash Flow by up to 15%

Inovalon, a leading provider of cloud-based software solutions empowering data-driven healthcare, announced that RCM Intelligence, a revenue cycle management (RCM) solution providing integrated analytics and data visualization capabilities, will now be compatible with all electronic data interchange (EDI) claims clearinghouses, connecting to commercial, Medicare, and Medicaid payers. Leveraging Inovalon’s advanced analytics, RCM Intelligence seamlessly operationalizes raw claims data to deliver real-time insights that improve cash flow, profitability, and productivity for healthcare providers without having to compromise performance based on which EDI clearinghouses they may be using. These insights include payer performance trends, claims corrections, cash projections, time-to-file rates, turnaround times, and denial percentages.

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Traditional RCM reporting is labor-intensive, inefficient, and generally manual, increasing the likelihood of errors and denials from health plans. Initial claim denials can occur up to 20% of the time and cost up to $118 per claim to rework, contributing to financial pressure on providers and delaying the availability of reimbursements. Providers often lack visibility into the root causes of these errors, thus impeding their efforts to improve the overall health of financial operations.

“RCM Intelligence provides insight that my EHR can’t. It’s easy to use and has proven especially valuable in achieving a very strong first-pass yield rate,” said Patricia Bemis, Director of Revenue Cycle at Brattleboro Retreat, a not-for-profit psychiatric and addiction treatment hospital. “I love that denials are categorized to identify problematic departmental workflows and that I can easily see what’s being worked on, where additional training might be needed, and how various team members perform.”

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RCM Intelligence saves valuable time and resources by eliminating the need for manual reporting and automating the delivery of actionable information such as associate productivity and high-impact tasks that can translate to cost savings. In addition, RCM Intelligence can identify which payers are reimbursing the slowest, where claims delays are occurring, and which denials have the highest claim value for prioritization. The result is higher first-pass yields of up to 93%, fewer days in accounts receivable aging, 40% fewer avoidable denials, less revenue leakage, and increased cash flow by up to 15%.

“Inovalon has decades of experience in b****** and processing healthcare claims, which we have leveraged for the purposeful development, and now expansion, of a truly transformative RCM software solution,” said Eron Kelly, President of Inovalon. “Now that RCM Intelligence is clearinghouse-agnostic, we can empower even more providers to turn insights into action and help them identify solutions, rather than problems, to maximize their ability to focus on delivering great care while our solutions support their productivity and economic efficiency too.”

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