What are Smart Data Solutions and Smart Data Stream’s quality control measures?

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What are Smart Data Solutions and Smart Data Stream’s quality control measures?

Smart Data Solutions and Smart Data Stream perform the following quality control measures:

Quality Control Module: Captured claim data is subject to quality control edits. For example, captured names are compared with a US Census Bureau listing of names. If the captured name does not match our census bureau database it is automatically subject to a second review.

Billing Line Quality Control: In this phase we compare the total charge with the sum of the line charges. In the event they do not agree, the claim is sent to the Billing Line Quality Control Module. This module allows for addition, removal and modification of billing lines.

General Quality Control Edits: Quality control edits fall into the following three categories:

  • Data Integrity Edits: Used to "tease out" data entry errors. For example, if the billing "from date" is after the "to date" the claim is subject to a second review.
  • Transformation Edits: This includes items such as name parsing and conversion from minutes to units for anesthesiology claims.
  • EDI Compliance Edits: This includes enforcement of EDI rules. For example, on a UB an occurrence code must be accompanied by an occurrence date.