Pre-Adjudication Edits

One of our core objectives is to ensure that SDS-sourced claims result in reduced labor and improved auto-adjudication. To that end, we offer the below auto-adjudication edits as part of our core service.


 

Pre-Adjudication Edits

One of our core objectives is to ensure that SDS-sourced claims result in reduced labor and improved auto-adjudication. To that end, we offer the below auto-adjudication edits as part of our core service.

Automated Provider File Matching: SmartMatch

SmartMatch is our proprietary automated provider matching utility. SmartMatch uses a weighted combination of proprietary and public domain string comparison algorithms. Its modular design and process of elimination approach enable very high match rates. Nearly all SDS clients use this to improve payment accuracy while reducing cost and turn-around time.

Implementations usually include some degree of customization to accommodate client-specific matching rules.

Automated Eligibility Matching: MemberMatch

MemberMatch also utilizes a blend of proprietary and public domain algorithms that automate eligibility matching. Specifically, we utilize weighted combinations of these algorithms to identify the correct match.

Over-Payment Protection: Clinical Editing (Ingenix) 

We offer the ability to subject client claims to the Ingenix clinical editing system.

Capture Workflow Applications

Rejected claims and claims requiring modification are an unavoidable consequence of th edata entry function. Reject processing is extremely time consuming and can introduce processing delays. To that end, SDS offerswork queues to help streamline transaction processing.

Customer Specific Edits

Smart Data Solutions' Edit Now edit framework enables the rapid development of custom edits. Nearly all of SDS implementations include custom edits and work queues.

Customer-Configured Edits

Customer-Configured Edits