We’re looking to automate our manual workflows such as matching of member and provider, repricing of a claim, etc. Does SDS help with that?

Posted by Smart Data Solutions on January 13th, 2020
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Smart Data Solutions

Yes. SDS will receive your member and provider files and run automated matching on every inbound claim. Claim data is compared against provider and member extracts in order to validate the data captured. This can also be expanded to ensure that the members are eligible for services based on their coverage periods and dates of service. Matching can also ensure that the provider listed is on file in your system. In both provider and member match cases, SDS can backfill any missing data and normalize information to match your expected formatting conventions to ensure the highest auto adjudication rates possible. If claims fail to pass member or provider checks, SDS can issue rejection letters back to providers alerting them of the discrepancy.

SDS also automates repricing of claims. Based on eligibility, we will route claims to primary networks and wrap networks until a repricing amount is applied.

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