search

MEDICARE CLAIMS MANAGEMENT SOFTWARE

Claims Management Medicare

Gain full visibility and functionality to manage your Medicare revenue cycle and improve your end to end workflows.

Request A DemoSee Our Payer List

Medicare Revenue Cycle Management Software

Take control of Medicare claims from first touch to final payment. Simplify reviews, identify issues before they cause delays, and gain full visibility into every audit, appeal, and reimbursement.

Medicare File Submission

An outline of a folder icon with a padlock and a password field, representing secure or protected files—ideal for illustrating Medicare Revenue Cycle Management Software security features.

Transmit Medicare Claims

Efficiently and cost-effectively transmit and process Medicare claims through a secure connection.

Direct Data Entry Verification

Two blue outlined arrows on a light gray background—one pointing left above the other, which points right—symbolize seamless flow, much like efficient Medicare Revenue Cycle Management Software. The simple lines show clarity and separation.

Access and Interact With the Medicare Standard System

Get secure, real-time access to FISS to check status, correct claims, and maintain credential compliance.

Claims Management Medicare Starter

A simple blue line drawing of a laptop with an envelope icon above the screen, suggesting the concept of sending or receiving email, ideal for illustrating Medicare Revenue Cycle Management Software communication.

Manage Audit and Appeal Workflows

Reduce workload and minimize claims delays with one place to submit and track ADR responses, RAC audit requests, and appeals.

Claims Management Medicare Pro

Simple line drawing of a person sitting in front of a computer monitor displaying a checkmark and text lines, symbolizing online learning or completing tasks digitally, such as using Medicare Revenue Cycle Management Software.

Manage Your Medicare Claim Lifecycle End-to-End

Protect your revenue by improving claim visibility and reducing denials with software that allows you to inquire, adjust, edit, and analyze Medicare claims.

Inovalon’s Medicare File Submission™

Monitor Medicare claims in one simple dashboard – with nationwide MAC connectivity, historical tracking, and fast, hassle-free setup.

A blue check mark inside two concentric blue circles on a light gray background, symbolizing approval or verification based on real-world data.

Send Claims Automatically

Submit claims and remits (837/835) directly to Medicare using a secure enterprise server. Skip the manual steps and speed up your process.

Simple line drawing of two hands shaking, symbolizing agreement, partnership, or cooperation based on real-world data, with blue outlines and minimal shading on the sleeves.

Stay Connected to Your MAC

Handle MAC changes without stress. Let Inovalon manage EDI transitions so you don’t need to reconfigure or lose connection.

Computer Filing Icon

Use a Simple Dashboard

Access a clean, intuitive system that works with any claims creation tool. Eliminate extra training and help your team move faster.

Inovalon’s Direct Data Entry Verification™

Connect in real time to FISS to enter claims, check status, and update RTPs without switching systems or slowing down.

Illustration of a clock with lines extending from its left side, creating a sense of fast movement or speed—ideal for representing efficient staff scheduling. The clock face is light blue and yellow, with simple hour and minute hands.

Connect to FISS Instantly

Securely access FISS to check claim status, append RTP claims, and enter new claims – all with a single click.

A simple bar chart with increasing bars and a line graph above them, highlighting quality improvement solutions with three circles marking key data points on the upward trend.

Scale With Your Organization

Supports organizations of all sizes allowing you to add as may users as your site needs, and includes built-in TN3270 access optimized for FISS.

A diagram of four blue gear icons connected by solid and dashed lines, symbolizing linked processes or systems, on a light background.

Reach Every MAC Nationwide

Connect to all Medicare Enterprise Data Centers and MACs through one secure, reliable solution.

Inovalon’s Claims Management Medicare Starter™

Stop scrambling with spreadsheets and paper. Take control of audits and appeals with fast, trackable electronic submissions.

Outlined icon of a computer monitor displaying a webpage with a large plus sign in the center, representing adding new content or creating something new on a website.

Track Everything in One Place

Track all ADRs, RAC audits, and appeals in easy-to-use Medicare revenue cycle management software – no more searching folders, juggling files, or risking missed deadlines.

A simple illustration of a clock next to a speedometer, both outlined in blue, symbolizing time and speed or efficiency.

Speed Up Response Times

Upload and send documents electronically without printing and mail delays. Handle audit requests as soon as they come in, and stay ahead of the clock.

An icon of an open envelope with a letter inside, featuring blue outlines and gradient shading. The letter displays three horizontal lines representing text, symbolizing quality improvement solutions in communication.

Cut Costs and Paperwork

Skip the printing, postage, and paper-chasing. Submit HIPAA-compliant responses securely online and save hours every week.

Inovalon’s Claims Management Medicare Pro™

Stop the Medicare waiting game. Identify errors instantly, fix delays early, and get paid faster with full visibility into every claim’s journey.

A simple illustration of a computer monitor displaying a warning symbol with an exclamation mark inside a triangle.

Fix Errors in Real Time

Get immediate visibility to processing issues so your team can catch and correct them before they turn into denials, delays, or lost revenue.

A simple illustration of a money bag with a dollar sign on it, next to a stack of coins, symbolizing wealth, savings, or financial growth.

Get Paid Without Delays

Cut out the guesswork with immediate visibility to current claim processing issues and the ability to take action on claim corrections for faster payments.

Icon of a document with lines representing text, next to a magnifying glass highlighting an upward trending arrow and bar graph, symbolizing data analysis or financial growth.

See the Whole Claims Journey

Track every step of your Medicare claims from creation to payment with 12-month visibility, clear reporting, analytic tracking and trending, and smart alerts that keep you ahead.

74%

Gained workflow efficiency1

of 25

All of the top 25 U.S. provider systems use Inovalon solutions2
HOW IT WORKS

Control Your Medicare Claims From First Touch to Final Payment

Medicare billing doesn’t have to mean chaos, delays, or paper overload. With Inovalon’s Medicare revenue cycle management software, providers can simplify claim reviews, fix issues faster, and get paid with more confidence.

Whether you're looking to move away from manual spreadsheets or need real-time access to claim statuses in FISS, our solutions are built to scale with your needs. Claims are easy to track, errors are easier to catch, and everything from audits to appeals stays organized, secure, and on time.

You'll have clear visibility into every Medicare claim, plus time-saving automations that reduce workloads and help your team stay ahead.

A computer monitor displays a data management software interface with tables, tabs, and navigation menus, featuring rows and columns of numerical and text data on a white background.

Claims Management Medicare Pro

Get real-time access to claims, fix errors instantly, and unlock full visibility into every step of the billing process.

Claims Management Medicare Starter product screenshot on a computer desktop

Claims Management Medicare Starter

Get real-time access to claims, fix errors instantly, and unlock full visibility into every step of the billing process.

TESTIMONIALS

Proven Medicare Results

Discover how healthcare organizations are reducing delays, cutting denials, and gaining confidence with real-time Medicare revenue cycle management software.

“

“Our facility is more confident accepting patients, thanks to Claims Management Medicare Pro. Many times, we get calls from facilities an doctors’ offices asking to take their patients. Thanks to Claims Management Medicare Pro, we can determine the patient’s Medicare and Medicare Advantage eligibility right away without waiting for the intake meeting.”

Johnny BlueBiller, St. Joseph Holdings
“

“Inovalon verifies the correct information and brings it right in so I can update the claim and submit it rather than having to go to Medicare to find the new (MBI) number.”

Nikki KnappAssistant Business Office Manager, Choctaw Nation Healthcare Center
“

“What Inovalon brings to the industry is the ability to foresee when an issue that starts at one point of your revenue cycle will have a downstream effect on another point. Having expertise to address those front-end issues so they don’t become back-end issues is a huge win for folks who partner with Inovalon.”

Kem TolliverPresident, Medical Revenue Cycle Specialists

Related Products

Explore companion solutions that reduce denials, simplify workflows, and help your team protect revenue from eligibility to remits.

Inovalon Claims Management details

Claims Management

Automate claim creation, submission, edits, and resubmission in one platform. Reduce denials, improve first-pass payments, accelerate reimbursement.

Inovalon Revenue Cycle Management Intelligence product details page

RCM Intelligence

Analyze your entire revenue cycle with dashboards showing claim aging, denial patterns, revenue performance, and future payments. Identify bottlenecks and make data-driven decisions to optimize revenue cycle performance.

Inovalon Registration workflow details page

Registration Workflow

Automate patient registration and verify identity, address, insurance, and benefits in one unified workflow. Prevent costly claim delays and give teams confidence by capturing accurate patient data upfront.

Inovalon Strategic Partnerships details page

Strategic Partners

Incorporate the technology, connections, and data to power your cutting-edge applications.

1. Inovalon internal reporting of keystroke reduction using Claims Management Medicare Pro vs. DDE. Inovalon internal reporting, July 2025
2. Top 25 provider systems based on Becker's Hospital Review list of 100 Largest Hospitals and Health Systems 2023. Inovalon internal reporting, January 2025.

Resources

A Smarter Revenue Cycle Starts Here

Explore expert guidance and real-world strategies trusted by leading healthcare organizations to strengthen revenue cycle performance, improve reimbursement, and achieve better financial outcomes