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The Inovalon Strategic Partner Program

Who is Inovalon?

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Nation’s first and largest network service vendor (NSV)

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20+ years of partnerships

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20+ year relationship
supporting Medicare

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3B+ transactions
annually3

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98% or better first pass payer acceptance rate4

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50k active, licensed customers5

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1.1M physicians

The Inovalon Strategic Partner Program

Discover how Inovalon can directly connect you to CMS and commercial payers, with streamlined data, integrated eligibility, and clearinghouse RCM workflows.

Inovalon gives Strategic Partners the technology, connections, and data to power their products and services. We aim to create a seamless working relationship that combines your industry expertise with our best-in-class technology to provide your customers with cutting-edge applications for RCM, eligibility verification, ADRs/appeals management, and more.

Here are three ways we help our Strategic Partners reduce costs across the healthcare industry:

110M+

MBI lookups

877

strategic partners1

43.04%

eligibility coverage
found on average2

Inovalon helps healthcare technology companies by supporting seamless delivery of services to their end-users. We have direct connectivity to Medicare, Medicaid (all states), most commercial payers, and Blue Cross Blue Shield. Our unique connectivity to Medicare allows us to serve the entire spectrum of healthcare technology:

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How Inovalon Helps

Inovalon combines your product with our technology in four key areas:

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1. All-payer revenue cycle management

Inovalon’s clearinghouse is the most advanced clearinghouse in the industry. Our platform sits atop an API layer that EMR partners can leverage, with a seamless claims management workflow and the most comprehensive set of payer validation rules capability to quickly build specific and unique business rules.

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2. API Management

Inovalon’s API Developer Toolkit was built to help you get to market quicker. Our suite of APIs assists you with pre-written requests and allows you to export code in multiple languages. Our connectivity to Medicare gives your clients full visibility into Medicare claims, remits status, and Medicare eligibility.

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3. Medicare-direct connectivity

For over 20 years, Inovalon has supported simple, affordable connectivity to Medicare. As the largest and longest-standing NSV, our clients receive a direct connection to Medicare.

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4. Clinical toolbox

Inovalon helps skilled nursing facilities (SNFs) with a robust process for collecting PDPM data across all payers and improves MDS management with increased data accuracy, reimbursement tools, and real-time reports to predict, detect, and prevent infection spread. Inovalon’s state of the art workforce management software helps clinical directors effectively manage clinical staffing, shift changes, PTO, and adherence to staffing compliance regulations.

RCM Workflow Solutions and Clearinghouse

We aim to create a seamless working relationship that combines your industry expertise with our best-in-class technology.

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Claims Management Pro™ – The Most Advanced Clearinghouse In The Market

Claims Management Pro allows EMR partners to leverage our API for seamless claims management workflow giving EMR partners access to the most complete denials and appeals management platform available today. We help our partners take control of claims management by scrubbing all commercial, Medicare, Medicaid, and Blues claims against our payer rules engine before submission. Customers will get full visibility and traceability of claims status from start to finish.

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DDE Claims Status Workflow – Connecting Your Platform To DDE

Whether through our proprietary Direct Data Entry (DDE) API or the intuitive user interface, we provide the technology to create systematic workflows for Medicare claims management. We enhance your efficiencies within DDE for claims status, ADRs, RTP, overlapping benefit periods, eligibility issues, and more.

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Enhanced Eligibility – Optimizing Your Eligibility Verification Process

We simplify the connection between multiple payers by enhancing eligibility requests with simpler and faster patient MBI capture.
You have access to instant MBI lookups, batch eligibility checks across all payers, and alerts to indicate other insurance coverage.

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Insurance Discovery – Identifying Active Coverage For Your Patients

Our Insurance Discovery software reduces uncompensated care and underpayments by identifying additional billable insurance coverage for patients. It returns an average of 43.04% insurance identification2 matches for accounts that would have been written off as self-pay, charitable, or bad debt. Your customers receive more reimbursement dollars with fewer denials by identifying more complex cases involving multiple payers.

Informed Decision-Making And Value‑Based Care

Healthcare providers struggle to access real-time, comprehensive patient data, impacting their ability to deliver value-based care and secure appropriate reimbursements.

Inovalon’s Patient Insights: Gaps in Care leverages a vast primary patient dataset to provide actionable insights into care gaps through seamless integration with existing technologies via FHIR®-based APIs.

With its unparalleled data coverage, including a nationally representative dataset from over 160 sources, and robust analytics across nearly 1,050 individual measures, the Gaps in Care functionality from Inovalon provides adaptable, secure, and compliant solutions for analyzing and addressing care gaps, enhancing the delivery of value-based healthcare.

82M+

12-Month Period

131M+

3-Year Period

159M+

5-Year Period

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Unique
Covered
Lives

Data Collective Highlights

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458M+

Medical Events

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99B+ 

Unique Lives

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50

States (+D.C. & P.R.)

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160+ 

Primary Sources

54%

Commercial

45%

Medicaid

6%

Medicare Advantage

3%

Other

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Partnership Options

Inovalon gives Strategic Partners the technology, connections, and data to power their products and services.

We can collaborate with you to meet your business needs through:

  • Referral Partnerships. Collaborate and integrate – leverage Inovalon’s connectivity and expert sales force to co-market our integrated solutions to your end users
  • Wholesale Partnerships. Inovalon provides you the data and connectivity to support your applications. Private-label our solutions and embed them into your platform to provide a seamless customer experience
    Both options provide a true partnership including dedicated, advanced support and partner account management teams.

Both options provide a true partnership including dedicated, advanced support and partner account management teams.

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For more information, contact us at (855) 915-1436

Together, we’re better.

1. Inovalon internal reporting, February 2025.
2. Inovalon internal reporting, March 2025. Individual results may vary.
3. Inovalon internal reporting, February 2025.
4. Inovalon internal reporting, Claims Management Pro, February 2025.
5. Inovalon internal reporting, January 2025.

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