Insurance Discovery

JSON twin: https://www.healthaidb.com/software/insurance-discovery.json

Company Name

Inovalon

Product URL

https://www.inovalon.com/insurance-discovery

Company URL

https://www.inovalon.com

Categories

• administrative Operations
• revenue Cycle
• patient Access
• cloud-based Solutions
• health Data Analytics
• Administrative
• Revenue Cycle Management
• Provider Cloud
• Data Analytics

Summary

Inovalon's Insurance Discovery is a cloud-based solution that identifies active, billable insurance coverage for patients, including primary, secondary, and tertiary plans, to reduce uncompensated care and improve revenue capture.

Description

Inovalon Insurance Discovery is a SaaS platform that utilizes algorithms and national payer data to identify active, billable insurance coverage for patients who appear uninsured or underinsured. It performs batch and real-time eligibility checks, returning consolidated coverage results to reduce days in accounts receivable, denials, and self-pay balances. The platform supports payer detection for managed care, Medicare Advantage, and commercial plans, and can be customized by facility and payer type to support front-end and back-end revenue cycle teams. It integrates with Epic, Cerner, and athenaHealth, expediting claim submissions, managing denials, and ultimately improving cash flow and maximizing reimbursements for providers. The platform is HIPAA compliant and stores and processes data in the United States. It supports FHIR data standards and offers an API for integration. Customers include Rockford Center / Universal Health Services, Phelps Memorial Health Center, HMG, and Skilled Nursing Group.

Api Available

yes

Certifications

• SOC 2 Type 2

Company Founding

1998

Company Offices

• United States

Compliance

• HIPAA
• GDPR

Customers

• Lapeer County Medical Care Facility

Data Residency

Data stored and processed in the United States

Data Standards

• FHIR

Deployment Model

• SaaS

Features

• All-payer insurance discovery (primary/secondary/tertiary)
• Verified demographic retrieval and correction
• Medicare Beneficiary Identifier (MBI) retrieval
• Single, fast payer inquiry (consolidated search)
• Customizable rules by facility/patient/state
• Automated retry timing for unavailable payer networks
• Coverage type detection (managed care, replacement plans, HMO/PPO)
• Reduce denials and days in A/R via verified coverage
• Improve patient financial clarity and reduce billing surprises
• Auditability and compliance-focused verification
• High-volume batch and real-time patient file analysis
• Integration with Inovalon ONE platform data lake

Id

SW1555

Integration Partners

Integrations

• Inovalon ONE® Platform
• Inovalon DataStream API
• Provider Directory API
• Patient Access API (Consumer Health Gateway)
• Medicare HETS database
• All-payer payer networks and claims systems

Languages Supported

• English

Last Updated

2025-10-11

License

Commercial

Market Segment

• Enterprise
• SMB

Optional Modules

• Eligibility Verification Pro
• Medicare Eligibility Verification
• Demographic Verification
• Patient Payment Management
• Patient Statement Management
• Registration Workflow

Os Platforms

• Web

Pricing Details

Contact vendor for pricing information.

Pricing Model

Subscription

Privacy Features

• GDPR compliance commitment
• US-based data storage and processing
• CCPA/CPRA consumer privacy support

Product Code

SW1555

Product Name

Insurance Discovery

Ratings

• 5.0 out of 5 (G2)

Regions Available

• United States

Related Urls

• https://elion.health/products/inovalon-insurance-discovery

Release Year

1998

Security Features

• Encrypted connections (in transit)
• Encrypted data handling (at rest)
• Authorization controls for APIs
• Access controls / role-based access
• Audit logging and monitoring
• Platform security checks (over 1,100 checks)

Specialties

• Managed Care
• Medicare Advantage
• Commercial Plans

Support Channels

• email
• phone
• chat
• ticketing
• community
• 24x7

System Requirements

Target Users

• Clinicians
• Nurses
• Admins
• Payers

Training Options

• documentation
• webinars
• live_online
• onsite
• certification

Type

product

User Reviews

• That we only need the resident's name and date of birth and we are able to see if the resident has any coverage and what the coverage is.

Version

1.0

Alternatives

See related products

Canonical JSON

{
  "product_name": "Insurance Discovery",
  "company_name": "Inovalon",
  "product_url": "https://www.inovalon.com/insurance-discovery",
  "company_url": "https://www.inovalon.com",
  "related_urls": [
    "https://elion.health/products/inovalon-insurance-discovery"
  ],
  "product_code": "SW1555",
  "summary": "Inovalon's Insurance Discovery is a cloud-based solution that identifies active, billable insurance coverage for patients, including primary, secondary, and tertiary plans, to reduce uncompensated care and improve revenue capture.",
  "description": "Inovalon Insurance Discovery is a SaaS platform that utilizes algorithms and national payer data to identify active, billable insurance coverage for patients who appear uninsured or underinsured. It performs batch and real-time eligibility checks, returning consolidated coverage results to reduce days in accounts receivable, denials, and self-pay balances. The platform supports payer detection for managed care, Medicare Advantage, and commercial plans, and can be customized by facility and payer type to support front-end and back-end revenue cycle teams. It integrates with Epic, Cerner, and athenaHealth, expediting claim submissions, managing denials, and ultimately improving cash flow and maximizing reimbursements for providers. The platform is HIPAA compliant and stores and processes data in the United States. It supports FHIR data standards and offers an API for integration. Customers include Rockford Center / Universal Health Services, Phelps Memorial Health Center, HMG, and Skilled Nursing Group.",
  "categories": [
    "administrative Operations",
    "revenue Cycle",
    "patient Access",
    "cloud-based Solutions",
    "health Data Analytics",
    "Administrative",
    "Revenue Cycle Management",
    "Patient Access",
    "Provider Cloud",
    "Data Analytics"
  ],
  "market_segment": [
    "Enterprise",
    "SMB"
  ],
  "target_users": [
    "Clinicians",
    "Nurses",
    "Admins",
    "Payers"
  ],
  "specialties": [
    "Managed Care",
    "Medicare Advantage",
    "Commercial Plans"
  ],
  "regions_available": [
    "United States"
  ],
  "languages_supported": [
    "English"
  ],
  "pricing_model": "Subscription",
  "pricing_details": "Contact vendor for pricing information.",
  "license": "Commercial",
  "company_offices": [
    "United States"
  ],
  "company_founding": "1998",
  "deployment_model": [
    "SaaS"
  ],
  "os_platforms": [
    "Web"
  ],
  "features": [
    "All-payer insurance discovery (primary/secondary/tertiary)",
    "Verified demographic retrieval and correction",
    "Medicare Beneficiary Identifier (MBI) retrieval",
    "Single, fast payer inquiry (consolidated search)",
    "Customizable rules by facility/patient/state",
    "Automated retry timing for unavailable payer networks",
    "Coverage type detection (managed care, replacement plans, HMO/PPO)",
    "Reduce denials and days in A/R via verified coverage",
    "Improve patient financial clarity and reduce billing surprises",
    "Auditability and compliance-focused verification",
    "High-volume batch and real-time patient file analysis",
    "Integration with Inovalon ONE platform data lake"
  ],
  "optional_modules": [
    "Eligibility Verification Pro",
    "Medicare Eligibility Verification",
    "Demographic Verification",
    "Patient Payment Management",
    "Patient Statement Management",
    "Registration Workflow"
  ],
  "integrations": [
    "Inovalon ONE® Platform",
    "Inovalon DataStream API",
    "Provider Directory API",
    "Patient Access API (Consumer Health Gateway)",
    "Medicare HETS database",
    "All-payer payer networks and claims systems"
  ],
  "data_standards": [
    "FHIR"
  ],
  "api_available": "yes",
  "system_requirements": "",
  "compliance": [
    "HIPAA",
    "GDPR"
  ],
  "certifications": [
    "SOC 2 Type 2"
  ],
  "security_features": [
    "Encrypted connections (in transit)",
    "Encrypted data handling (at rest)",
    "Authorization controls for APIs",
    "Access controls / role-based access",
    "Audit logging and monitoring",
    "Platform security checks (over 1,100 checks)"
  ],
  "privacy_features": [
    "GDPR compliance commitment",
    "US-based data storage and processing",
    "CCPA/CPRA consumer privacy support"
  ],
  "data_residency": "Data stored and processed in the United States",
  "customers": [
    "Lapeer County Medical Care Facility"
  ],
  "user_reviews": [
    "That we only need the resident's name and date of birth and we are able to see if the resident has any coverage and what the coverage is."
  ],
  "ratings": [
    "5.0 out of 5 (G2)"
  ],
  "support_channels": [
    "email",
    "phone",
    "chat",
    "ticketing",
    "community",
    "24x7"
  ],
  "training_options": [
    "documentation",
    "webinars",
    "live_online",
    "onsite",
    "certification"
  ],
  "release_year": "1998",
  "integration_partners": [],
  "id": "SW1555",
  "slug": "insurance-discovery",
  "type": "product",
  "version": "1.0",
  "last_updated": "2025-10-11",
  "links_json": {
    "self": "https://www.healthaidb.com/software/insurance-discovery.json"
  }
}