Inovalon RADV Audit Readiness Solution Earns Top Ranking From Black Book

Inovalon, a leading provider of solutions empowering data-driven healthcare, has been named the top-rated vendor for the End-to-End Medicare Advantage (MA) Risk Adjustment Lifecycle by Black Book Research. The ranking was based entirely on evaluations from nearly 1,000 IT, finance, and operational leaders from MA plans.

This recognition comes at a pivotal time for MA plans after the Centers for Medicare & Medicaid Services (CMS) recently released plans to expedite Risk Adjustment Data Validation (RADV) audits and recover identified overpayments. The rollout will mandate RADV audits for all eligible MA plans annually and accelerate audits for payment years 2018 through 2024. Accurate, well-documented risk score submissions and surveillance technology to maintain compliance helps plans address the elevated risk of financial penalties, operational disruptions, and reputational harm.

“Medicare Advantage plans are under increased scrutiny from CMS, and there’s urgency for these organizations to prepare for RADV audits as part of their regular operation, not just when CMS comes calling,” said Mike Jones, President of Inovalon’s Payer Business Unit. “At Inovalon, we’re committed to delivering risk adjustment and quality software that empowers Medicare Advantage plans to get it right from the start and drive better outcomes. Black Book’s recognition further validates our risk and quality solutions as the most complete package on the market, which allows health plans to thrive within a rapidly evolving regulatory landscape.”

Inovalon’s Converged Risk™ solutions, including Converged Risk Surveillance Analytics™ and Converged Record Review™, are designed to help MA plans proactively prepare for RADV audits and improve risk score accuracy. Additionally, Converged Quality™ is proven to aid in improving CMS Star Ratings and closing care gaps through advanced analytics and member engagement tools. Ranked #1 by Black Book across 18 performance indicators, including RADV readiness, coding accuracy, and real-time insights, these solutions offer a unified and comprehensive risk adjustment ecosystem that spans encounter data aggregation, clinical documentation improvement, and star rating measure optimization.

“CMS’s aggressive audit expansion demands more than risk scoring – it requires a complete transformation of how MA plans use data,” said Doug Brown, Founder of Black Book. “Inovalon is a top-rated vendor, standing out for its ability to provide a truly end-to-end ecosystem for risk adjustment and quality that provides audit defensibility, quality improvement, and operational control.”

Approximately 60% of MA enrollment flows through health plans that rely on Inovalon’s Converged suite. These software solutions support plans in improving clinical quality metrics, risk score accuracy, value-based care, and more by transforming manual workflows into data-driven processes. In 2024, Inovalon’s customers realized a 5% increase above the national average, with four of the seven (57%) 5-star health plans using Inovalon’s Converged Quality solution –achieving the highest MA rating available.

For more information about Inovalon’s Payer solutions suite and how it can help your organization prepare for CMS mandates, please visit www.inovalon.com/radv-audit/.

About Inovalon

Inovalon is a leading provider of cloud-based SaaS solutions empowering data-driven healthcare. The Inovalon ONE® Platform brings together national-scale connectivity, real-time primary source data access, and advanced analytics into a sophisticated cloud-based platform empowering improved outcomes and economics across the healthcare ecosystem. The company’s analytics and capabilities are used by over 50,000 active, licensed customers, and are informed by the primary source data of more than 91 billion medical events across 1.1 million physicians, 697,000 clinical settings, and 410 million unique lives. For more information, visit www.inovalon.com.

About Black Book

Black Book™, along with its founders, management, and staff, maintains no financial interest in any vendors included in its surveys, such as Inovalon. The organization publishes the results of satisfaction and client experience rankings and shares them with the media before notifying vendors. It does not solicit participation fees, review fees, inclusion or briefing charges, or vendor collaboration during its polls. Since 2000, Black Book™ has surveyed vendor satisfaction across over 30 industries globally in the software, technology, and managed services sectors. In 2009, Black Book began polling over two million healthcare software and services users to gauge client experience. It has built a reputation for independent, unbiased, crowd-sourced surveys among IT and health records professionals, CFOs, medical officers, physician practice administrators, nurses, financial leaders, executives, and hospital IT managers. The 2024 payer IT client experience polls were conducted over seven months through multiple research events.

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