Medicare Revenue Cycle Management Software

Simplify Medicare billing with automated, cloud-based software that helps you manage cash flow projections, claims status, and eligibility issues.

Claims Management Medicare Pro, Powered by the Inovalon ONE® Platform

Submit, manage and correct Medicare claims quickly and easily with a proven tool that eliminates guesswork and maximizes productivity.


Automate your Medicare billing management with specialized Medicare revenue cycle management software that corrects complex and multi-step claims, flags receivables at risk and allows you to perform easy eligibility look-ups.

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Monitor eligibility

Verify Medicare eligibility status and receive weekly alerts for patients who switch between traditional Medicare, Medicare Advantage or an HMO plan.

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Manage billing

Access interactive reports for visibility and control of Medicare revenue. Quickly spot eligibility issues, monitor for claims stuck in suspense, work through RTP claims, or review projected reimbursements.

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Automate RAC audits and ADRs

Receive automated alerts, assemble and upload required docs, and submit through the CMS HIPAA-compliant electronic portal. Afterwards, easily track the status of your response through its lifecycle.


Take control of your Medicare billing and A/R with Claims Management Medicare Pro.

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Expand your view

Gain real-time visibility into actual payments and forecasted revenue.

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Stay up to date

Access timely information on Key Performance Indicators (KPIs).

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Verify eligibility automatically

Receive weekly automatic checks to verify Medicare eligibility status and Medicare as a secondary payer.

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Keep track of all documents

Benefit from secure, electronic medical documentation submission and tracking for ADRs, RAC audits and appeals management.

How it Works

Eliminate delayed and lost revenue by automating time-consuming processes such as checking Medicare eligibility and claims status, fixing rejected claims and more.

Discover why providers trust Inovalon's Medicare revenue cycle management software for Medicare billing management.

Successful management of Medicare billing is critical for home health agencies, hospices, skilled nursing facilities, hospitals, and FQHCs. It’s essential that providers control time and money spent on ADRs and process such as audit and Level 1 and 2 appeals.

With Claims Management Medicare Pro, you can keep track of everything securely and efficiently to improve both revenue flow and your understanding of receivables at risk. The analytics feature drills down further, with reports that provide you with continuous awareness of potential revenue leakage. You can get a summary of all claims statuses or focus on itemized claims status. Plus, the software provides a daily email informing you of Medicare dollars you’ll receive that day, and expected dollars for the next day.

Product Sheet

Frequently Asked Questions

Can I correct RTP claims?

Yes! You can correct and resubmit RTPs in this application.

Is custom reporting available to project Medicare dollars?

Yes! We have many built-in reports to help you track Medicare dollars, and you also have the option to generate custom reports to drill into your organization’s unique interests.

Does this application do sequential claims processing for Medicare?

Yes! We automatically do sequential claims processing, even after corrections. For example, if you have claims from January-March to submit, but January’s claim had an error, the claims for January through March will automatically submit once the error on the first claim is fixed.

Can this help us with pre-claim review and Review Choice Demonstration (RCD)?

Yes! We are here to support you in navigating this requirement.


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

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Questions? Call (301) 809-4000

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