Inovalon Announces Converged Submissions To Support Health Plan Risk Adjustment Programs

Medicare and Commercial Affordable Care Act Plans Can Easily Deploy New Cloud-Based SaaS Solution to Submit Encounter Data to CMS to Support Their Risk Adjustment Programs, Improve Compliance, and Drive Stronger Economic Performance

BOWIE, Md., March 18, 2024 (GLOBE NEWSWIRE) — Inovalon, a leading provider of cloud-based software solutions empowering data-driven healthcare, launched Converged Submissions today to simplify and improve encounter data submissions in support of risk adjustment programs. This cloud-based SaaS solution is part of Inovalon’s Converged Risk Solution Suite and analyzes encounter data to determine risk adjustment eligibility and deliver complete and accurate encounter data submissions on demand. Health plans with risk-adjustable lives using Converged Submissions receive proactive insights to validate data, correct errors, and prioritize submission efforts to achieve higher first-pass acceptance rates for greater financial impact and efficiency. 

The Centers for Medicare & Medicaid Services (CMS) requires Medicare Advantage (MA) plans, Medicare-Medicaid plans, and Commercial Affordable Care Act (ACA) plans to submit encounter data that is used to evaluate and accurately reimburse the health plans. Incorrect submissions and errors can delay payments anywhere from 6 to 18 months and must be corrected to avoid financial impact or regulatory penalties. Most solutions available today are reactive and wait to correct claims that CMS rejects causing further delays and acceptance rates as low as 80%. Health plans using Inovalon’s solutions average 94% to 99% acceptance rates.

Converged Submissions leverages customer data feeds and analytics informed by Inovalon’s MORE² Registry^®, the nation’s largest longitudinal primary source healthcare dataset, to train an advanced pre-validation and correction analytics engine, empowering a superior error catch rate and auto correction of data capability. Combined with comprehensive, up-to-date regulatory and submission rules algorithms, these capabilities are designed to maximize first-pass acceptance rates for help health plans, reduce expensive errors, avoid claim rejections from CMS and the Department of Health & Human Services (HHS), and accelerate reimbursements. Additionally, Converged Submission’s cloud-based architecture provides for industry-leading scalability, reliability, and on-demand usability so that customers of all sizes can undertake data submission updates easily and at whatever frequency they may want, enabling greater financial visibility and end-to-end reporting transparency. 

“Lack of subject matter expertise in encounter data submissions and evolving CMS requirements lead many health plans to overspend on labor and technology, or worse, miss submission deadlines, which leads to delays in payments,” said Mike Jones, President and General Manager at Inovalon. “Health plans need insights into the complex risk adjustment submissions process and solutions that adhere to CMS regulations. Converged Submissions fulfills these requirements across encounter data and supplemental data submissions in a highly accurate, efficient, fully integrated product suite that reduces the likelihood of delayed reimbursements.”

Powered by the Inovalon ONE^® Platform, Converged Submissions is fully interoperable with Inovalon’s complete Converged Solution Suite for health plans to optimize quality initiatives, value-based care agreements, risk score accuracy, member engagement, and more. Customers of any one of Inovalon’s Converged Solution Suite products can easily activate additional products within the suite, reducing time-to-impact, avoiding redundant data provision risks and costs, and increasing operator team efficiency.

For more information on Converged Submissions, go to inovalon.com/encounter-submissions, and visit Inovalon at RISE National Booth #405 in Nashville, TN.

About Inovalon

Inovalon is a leading provider of cloud-based software solutions empowering data-driven healthcare. The Inovalon ONE^® Platform brings together national-scale connectivity, real-time primary source data access, and advanced analytics into a sophisticated cloud-based platform empowering improved outcomes and economics across the healthcare ecosystem. The company’s analytics and capabilities are used by nearly 20,000 customers supporting over 50,000 sites of care, and are informed by the primary source data of more than 81 billion medical events across 1.1 million physicians, 661,000 clinical settings, and 380 million unique lives. For more information, visit www.inovalon.com.

Contact:
Tom Paolella
Sr. Director, Press and Analyst Relations, Inovalon
Thomas.Paolella@inovalon.com