Posted by Smart Data Solutions on November 13th, 2012
Smart Data Solutions

St. Paul, Minnesota — November 13, 2012 — As today’s medical costs continue to rise, insurance payers are exploring options for further medical cost containment within their claim operations. Automating workers’ compensation claims is a significant part of these cost reduction initiatives. The automation of workers’ compensation processing saves both time and money by simplifying the detection process for fraudulent, unauthorized, or duplicate claims.

Payers need an efficient solution that integrates into their workflow. Automated workers’ compensation claim processing streamlines the overall process by automatically employing audits that check member-matching criteria set forth by a payer. These audits save money by also identifying and eliminating inaccurate, duplicate, and erroneous charges. This ensures that claims are meeting payers’ quality standards and necessary accuracy. These quality standards are implemented based on analysis of the relationship between procedure cost, diagnosis and coverage.

“At Smart Data Solutions, we understand the importance of automated bill review for greater efficiency and accuracy to help reduce workers’ comp claim costs and processing time,” affirms Pat Bollom. “With our solution we also place great importance on integrating the automated system with our claims reporting and tracking feature, as well as 24×7 support by a dedicated developer.”

The Smart Data Solutions model accomplishes all of the above. Their reporting process starts immediately with pre-determined triggers from a work-related accident. The bill is then subject to several reviews including payment review, case management review, and utilization review. Next, the necessary transaction discounting is applied, interfacing with PPOs and the required state discount schedule. Finally, the payment is made and the bill is sent to the required state reporting. Smart Data provides the additional benefit of archiving the bill is for tracking and analyzing of all workers’ compensation claims.

Smart Data Solutions provides a comprehensive claims management system that automatically integrates mailroom, data capture, data editing, EDI clearinghouse solutions and a variety of custom solutions critically needed by today’s healthcare industry. In addition, Smart Data clients can quickly and easily view documents, reports and automated alerts throughout the claims process. Today, more than 140 TPAs, PPOs, HMOs, hospitals and insurance companies depend on SDS technology to save money and streamline their business. From paper processing to claims management and EDI, Smart Data Solutions offers the solutions critically needed by today’s health care industry. For more information about Smart Data Solutions please visit our web site at, contact Pat Bollom at 651.690.3140 or email pbollom [at] sdata [dot] us.

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