Smart Data Solutions incorporates artificial intelligence, hardware, and software solutions, streamlining the entire mailroom intake and data capture process.

We utilize four independent OCR systems through which all documents are passed through twice. Based on pre-established confidence levels, if there is disagreement on the capture fields after two passes, the field is processed through our unique ‘Smartzone snippets’ data verification system.

We continue to monitor and curate our OCR and Machine Learning Models to provide the highest possible accuracy.

Member-related issues continue to be one of the leading causes of rejections for payers. These discrepancies can consume lots of resources on both the payer and provider side. Member identification issues lead to time spent by your analysts reviewing claims, your service reps responding to provider questions, and ultimately all of the additional work required to process the claim again once it is resubmitted. Our inline member validation processes compare claims against your member extracts, validating and cleaning the data as it passes through our AI platform. We are able to identify the patients and subscribers, validate that the members had active coverage for the dates of service, and identify any PPO affiliations to begin the repricing processes. All data is then cleaned and normalized into the exact formats your system expects, reducing your pends and increasing your auto-adjudication rates.

We will configure edits and process rules that will automate rejected documents and reduce the need for manual intervention and review.

Identifying, tracking, and managing provider records can be a challenge for many payers. Issues such as minor variations in a provider’s name or address could potentially create dozens of duplicate records, which may lead to billing problems, payment problems, or complications filing tax information. Ultimately, all of this can lead to confusion, frustration, and potentially a large amount of extra work. By screening claims against your provider extracts, or the NPI database, Smart Data Solutions is able to ensure that the provider information we send matches the records in your system, eliminating duplication issues. When a new provider is detected, our AI platform identifies these cases and notifies your analysts allowing you to create the provider record the way you want it.

Smart Data Solutions transforms and delivers your data based on our ability to apply client-specific edits, leveraging our extensive library of healthcare edits.

This customized editing process allows for the application of client workflows and data validation prior to export. We will apply the edits to identify missing, invalid data or errors and correct the data to ensure valid data sets.

Our objective is to deliver clean data files to enhance the auto-adjudication process.

While rejects or issues can happen anywhere, detecting them as far forward in the process as possible streamlines all downstream workflow saving time, money, and increases overall efficiency. At Smart Data Solutions, we look at all possible reject-points in the workflow and establish review queues for your analysts to review and handle the pieces that reject. Smart Data Solutions’ integrated rejection and fallout queues provide tools and solutions which allow your analysts to:

• Review documents that fail EDI compliance screening or business rules.
• Correct or update rejected documents, releasing them back into the processing workflow.
• Reject a claim back to a provider by issuing a rejection letter citing the reason for the rejection and the re-submission instructions.

Smart Data Solution uses an automated rules engine, to transform the various data formats into the file format specified by the client and then deliver this to the client electronically.

We export files to clients in various formats which include 837, NCPDP, CSV, JSON and XML.

Our workflow queues allow clients to perform key tasks within QuickClaim before the exporting of documents.  This allows for an upstream process that improves overall auto-adjudication.

We know how important SLAs and tracking metrics are to managing your production volume. These statistics provide you with the peace of mind to know that your quality standards, TAT, and response times are all within contractual limits. To that end, our QuickClaim web portal is a fully transparent window into our processes, showing you where your documents are every step of the way. Additionally, we provide integrated reports and email alerts at the intervals needed by you and your team allowing you to address issues before they become problems.

Moreover, Smart Data Solutions performs consistent and continual auditing of all documents processed. The audits review data at the field level and can tie the information back to a manual keyer or OCR model. The audited information is reported regularly to clients with full transparency.