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Target and Close Risk Gaps With Confidence

Reduce compliance concerns with precise documentation

Increase Risk Gap Closure While Remaining RADV Compliant

Ensure efficient, precise member documentation and accurate reimbursement with Inovalon’s Converged Risk, a scalable, end-to-end software solution.

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Benefits

Reduce the complexity of your risk reporting with the transparency of our suspecting algorithms, informed by the industry’s largest primary source dataset.

Two stacks of horizontal rectangles with dotted lines inside, connected by curved arrows pointing in opposite directions, suggesting Real World Data transfer or synchronization between the stacks.

Seamless Integration

Unify your internal and external providers with the Inovalon ONE® Platform.

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Return on Investment

Ensure adequate compensation with improved risk score accuracy and documentation.

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Best Care Outcomes

Gain a trusted partner that empowers you to offer the best care to your patients.

CONSERVATIVE

Adjustable and customer-selected targeting thresholds

Health plans can control interventions by utilizing custom and adjustable thresholds.

Converged Risk’s analytical approach allows you to identify persistent conditions, under-coded and/or suspected conditions, and over-coded conditions lacking clinical evidence.

Plus, target risk gaps with provided confidence levels that enable you to control your intervention thresholds, regardless of the line of business.

QUALITY AND RISK, EMPOWERED
Two donut charts use Real World Data to compare Medicare and Retail/Commercial categories, highlighting proportions of un-coded chronic conditions (dark blue) and suspected conditions (teal). Arrows and the label Adjustable Threshold are also shown.
QUALITY AND RISK, EMPOWERED
Bar chart using Real World Data to show Net EDD score distribution for chronic conditions. Highlights un-coded, suspected, and over-coded cases. Y-axes display EDD score and true positive prevalence percentage, with labels clarifying each category.

COMPLIANT

Risk gaps informed by expert analytics

Seamlessly stratify entire populations based on patient conditions and confidence thresholds with metrics such as risk score opportunity, trend, forecasting, and re-capture rate.

TRANSPARENT

Transparency you can trust

Clearly view member-level clinical evidence that informs gap identification such as historical claims, Rx, labs, and more.

QUALITY AND RISK, EMPOWERED
A dashboard screen displays a table of member details by opportunity, integrating Real World Data such as member IDs, names, opportunity IDs, product types, providers, and enrollment dates, with filter and navigation options visible at the top.

Discover what customers have said about Inovalon solutions

Read what customers across the continuum of care have to say about Inovalon solutions.

Our providers are now more engaged and more involved. Trust, transparency, and support are key – and Inovalon helps us have all three.

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Tony Graboski Account Manager, Geisinger Health Plan
Geisinger Health Plan logo with Geisinger in large blue letters above Health Plan in smaller gray letters on a light background, representing success stories in healthcare coverage.

Inovalon has enabled some unique improvements to our processes, and the company’s culture was consistent with ours. They have helped us with some enhancements that have made a big difference.

A woman with curly hair smiles joyfully while holding a red apple in her hand, standing in a sunlit field during golden hour, capturing a vibrant moment that feels as authentic as real world data.
Steve Flannery Division Director of Reimbursement Services, BAYADA
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I’ve never found another system to get claims to Medicare. Claims Management Medicare Pro is amazing – we can do the same thing, but in a better way.

A woman with curly hair smiles joyfully while holding a red apple in her hand, standing in a sunlit field during golden hour, capturing a vibrant moment that feels as authentic as real world data.
Marco Ochoa A/R Manager
Logo for MGM Healthcare featuring “MGM” in purple script inside a circular outline, with “Healthcare” in blue cursive and the tagline “Empowering Better Living” in gray beneath.

Implementing Schedule Management has been, hands down, the most immediate value-added business solution and user-friendly technology I’ve been a part of in 25 years of healthcare operations.

A woman with curly hair smiles joyfully while holding a red apple in her hand, standing in a sunlit field during golden hour, capturing a vibrant moment that feels as authentic as real world data.
Holly Shepherd Regional Director of Operations, Providence Home and Community Care
Providence logo with a blue and green cross design on the left and the word Providence in blue text on the right.

There’s so much that Inovalon has brought to the provider community with automation efficiency that has made a huge difference. Inovalon has the best clearinghouse and functionality that exists.

A woman with curly hair smiles joyfully while holding a red apple in her hand, standing in a sunlit field during golden hour, capturing a vibrant moment that feels as authentic as real world data.
Julie Ann Kemman President, Health Care Professional Consulting Services
Logo for Health Care Professional Consulting Services, Inc. with the acronym H.C.P.C.S. in blue script, a stylized medical symbol on the left, and a horizontal and vertical gray line beneath the text.

Reducing our A/R days from the 90s to the 30s has given our organization greater financial stability. We’re able to grow our services and our physical landscape of the hospital. We’ve added more specialists to the facility that our patients need.

A woman with curly hair smiles joyfully while holding a red apple in her hand, standing in a sunlit field during golden hour, capturing a vibrant moment that feels as authentic as real world data.
Rachel Dallmann Revenue Cycle Director, Phelps Memorial Health Center
Logo for Phelps Memorial Health Center featuring a maroon circle with Phelps Memorial Health Center around the border and a white banner with PMHC in bold maroon letters across the center.
A woman sits at a desk working on a laptop. The text reads: Inovalon 4 Strategies for an Effective Risk Adjustment Program Using Real World Data. The background is a gradient blue, in a modern office setting.

Infographic

4 Strategies for an Effective Risk Adjustment Program

Learn exactly where your risk adjustment program is lacking and how Converged Risk incorporates these strategies for a strong risk adjustment program.

View Infographic
Two diagrams use Real World Data to illustrate risk: the left, labeled “Low Overcoding Risk,” shows many arrows and icons; the right, labeled “High Overcoding Risk,” features fewer arrows and a single icon marked “Claims.”.

Webinar

CMS RADV Compliance: A Proactive Approach

In the 2023 CMS RADV Final Rule, CMS adopted statistical modeling and analytics to identify “High-Risk Groups of Diagnoses” that are deemed the highest priority for recouping improper payments.

Watch Webinar

Ready to see the software in action?

 1 Inovalon internal reporting. April 2024