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
Author
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.

Recent Articles

View All 

Patient Experience - What It is, Why It Matters & How To ...

When it comes to healthcare—whether providing services or facilitating the process of those services, providing ...
Read Article

Healthcare Clearinghouse: What it is and How it Can Help

A healthcare clearinghouse is essentially the middleman between the healthcare providers and the insurance payers. A ...
Read Article

5 Best Practices for Automation in Healthcare

Automation and healthcare tend to go hand in hand these days. With continual advancements in technology, digitization of ...
Read Article

Why handle the heavy lifting of your claims workflow when a smart team enhanced by AI can?

Achieve peace of mind, reduced costs, and greater process efficiency by automating and consolidating your data workflow.

Start Customizing Your Solution