Healthcare Insurance Coverage Discovery Software

Find more active coverage with superior healthcare insurance coverage discovery software that simplifies identifying billable insurance.

Powered by the Inovalon ONE® Platform

Using proprietary algorithms, our solution searches multiple commercial and government payers to find active primary, secondary, and tertiary coverage for self-pay accounts.

Overview

ABILITY Insurance Discovery reduces uncompensated care and underpayments by identifying active billable coverage previously unknown to the provider. Using sophisticated search capabilities, this solution identifies if patients have multiple active payers to help boost reimbursement opportunities.

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Improve coverage results

Gain an overall average insurance identification hit rate of 39.7% on uninsured accounts across all care settings.1

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Lower days in A/R and denials

Prevent reimbursement delays and increase the speed of revenue capture by sending claims to the right payers on first submission, enabled by more accurate coverage information.

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Conduct more in-depth searches

Identify more complex cases with multiple commercial and government payers to ensure claims are sent to every applicable group.

39.7

Overall average insurance identification hit rate on uninsured accounts across all care settings.1

2.6

Patient files analyzed in 2021 from 306 customer accounts.2

154.8

Potential additional revenue for providers in 2021, at a conservative reimbursement rate of $150 per patient.3

1Inovalon internal reporting, July 2022. Individual results may vary.

2Inovalon internal reporting 2022. 2021 actual customers.

3Inovalon internal reporting, 2022. Realization of reimbursement for identified coverage may vary; dependent upon payment processes.

Benefits

Replace manual insurance discovery methods with one quick, comprehensive search that inquires numerous databases in seconds to deliver detailed, accurate coverage information.

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Demographic verification

Verify nine key elements in real-time, including name, address, date of birth, phone number, and Social Security Number.

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Expanded payer search

Find up to double the number of payers4 compared to other searches with an all-payer search that delivers a complete view of coverage.

4Average of customer results. Inovalon internal reporting 2022.

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Customizable workflow

Create custom rules based on facility, patient, state, and payer. Plus, set timing intervals to retry searches if a payer network is inaccessible.

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Enhanced coverage detection

Discover all applicable coverage including managed care plans, advantage replacement plans, and lists of relevant plan types (HMO, PPO, etc.).

How it Works

Advanced proprietary algorithms do the heavy lifting for you, searching multiple databases to find active billable coverage – all through one simple inquiry.

Identify every applicable payer for every patient.

ABILITY Insurance Discovery is a healthcare insurance coverage discovery software that helps ensure all active billable coverage is identified for a claim. Its robust algorithms search patient information against public and private payers to identify primary, secondary, and tertiary coverage – with confidence scoring and differentiation between managed care and advantage plans.

Search results are highly configurable. Filters can organize files by patient name, transaction date, coverage status, NPI, and payer. The results are delivered within seconds for single inquiries and batch inquiries are completed within 24 hours, searching thousands of patients’ coverage with just one file upload.

Real-World Applications

Healthcare insurance coverage discovery software that takes the guesswork out of finding billable coverage. Streamline workflows and improve collections with ABILITY Insurance Discovery.

During patient access

Identify unknown patient coverage before patients even see their provider, setting up every claim for success in the downstream of the revenue cycle.

Back-end revenue recovery

Seize revenue opportunities from underinsured and self-pay accounts. Find active payers with coverage discovery software before going to collections.

In every care setting

From small practices to large health systems, every dollar counts. Ensure reimbursement across hospitals, home health agencies, SNFs, and more.

Product Sheet

Frequently Asked Questions

What insurance information is returned when coverage is found?

When active coverage is identified, the plan type, member ID, and MBI will appear. High-level benefit data may also appear.

Are there any payers you cannot verify coverage against, or for which a Subscriber ID is required?

The software makes logical deductions to find insurance for a patient based on the patient and provider information. Some payers are harder to locate due to the fact they require a Subscriber ID.

What is the processing time for a single inquiry?

A single inquiry takes about 15 seconds to return a response.

What is the processing time for a batch inquiry for many patients?

A batch file inquiry typically returns results in less than 24 hours. However, processing time may be affected by the size of the file, the number of patients, if any payers are down, and the number of files in the queue to be processed.

What is the implementation timeline?

The average implementation time for this healthcare insurance coverage discovery software application is 30 days.

Resources

Provider Resources

Gain insights from Inovalon case studies, infographics, videos, and other resources to get the most out of our products and solutions.

Let’s transform healthcare
together.

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Questions? Call (301) 809-4000

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