Innovista’s utilization management (UM), compliance, and referral coordination teams work together closely to support providers in delivering clinically necessary and effective care with minimal administrative burden.
Innovista has a skilled claims management team that ensures claims are processed properly, ultimately saving operational costs due to efficiency. Services include:
Innovista has a full-service customer service team that supports all provider and member inquiries during the weekday, with an after-hours hours answering service for evenings, weekends, and holidays. The team is staffed with bilingual representatives for our Spanish-speaking members and has a language interpreting service line to support all other languages.
Innovista consistently exceeds the requirements set forth in the Medicare Advantage Communications and Marketing Guidelines, which mandate a rate of greater than 80% of calls answered within 30 seconds, and less than 5% abandon rate for calls.
The team assists in a wide range of member/provider inquiries, including eligibility and referral status verification, claim status, and benefit inquiries.