Scanning & Data Capture

Smart Data Solutions provides fully customizable and automated scanning and data capture processes that leads to faster turn-around times, higher accuracy of claim data, and reduced costs.

 

Scanning and Data Capture

Smart Data Solutions provides fully customizable and automated scanning and data capture processes that leads to faster turn-around times, higher accuracy of claim data, and reduced costs.                     

Smart Data Solutions utilizes a variety of capture and quality control subsystems to ensure rapid and accurate return of claim data. Below is a brief overview of these subsystems:

  • Optical Character recognition (OCR): Smart Data Solutions utilizes OCR to improve quality, reduce costs and shorten turn-around time.
  • Key From Image (KFI): Claims that cannot be processed by OCR are routed to our internally developed KFI system. Our KFI system also includes low level validation edits.
  • 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 data base it is automatically subject to a second review.
  • Base Double Key Module: Smart Data Solutions utilizes "OCR Enhanced" double key. This provides highly accurate data using less labor thus reducing client costs. The double key module can be used on selected fields or the entire claim.
  • Enhanced Double Key Module: We use this for super critical fields. This process is triggered in the event the referee keyer does not agree with either of the two previous keyers. In this situation the field is again keyed by a senior keyer. This approach further increases accuracy.

Capture Security

Smart Data Solutions data capture systems are highly secure. Specifically, claim data and claim image files do not leave our Minnesota facilities.  Also, our keying facilities include secure access, employee background checks and PC hardware with no removable storage devices. Finally, we utilize both IP address restrictions and multi-tiered passwords to control system access.

Audit

Smart Data Solutions utilizes an ISO compliant audit system. The system is unique in that it incorporates real time corrective audits. This approach yields two benefits. First, any errors identified in audit are corrected prior to export thus improving client data. Second, the keyers are provided error feedback within four hours of keying. This rapid feedback allows us to identify and correct keying errors rapidly.

Error Feedback Report

Error Feedback Report

Data Capture Workflow Applications

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

RejeXpro Rejects Processing Queue

RejeXpro enables the review and modification of transactions that would have otherwise been rejected. (The criteria for routing to the queue are set on a per client basis.) Once in the queue, claim or eligibility transactions can be modified to enable accurate submission. For example, the rendering physician name may be illegible on the claim form. Using RejeXpro, we can avoid a reject by identifying the physician name, populating the transaction and resubmitting.

WebKey Form

WebKey Form

Modiff - I Transaction Modification Queue

Clients sometimes need to modify transactions prior to submission to their adjudication system. For example, claims subject to clinical editing may be materially modified including the addition and removal of billing lines. With Modiff-I, the client can revise the transaction and resubmit it to the PPO for repricing. (This queue can be used for paper or EDI sourced transaction.)

Eligibility Review Queue

This system enables the client to specify conditions in which eligibility matches are reviewed. Typically, the SDS MemberMatch application enables fully automated eligibility matching. However, there may be situations such as incomplete eligibility data in which the client specifies manual review. This queue enables that review.