What is SDS’s data capture and data entry workflow?

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

SDS’s data capture and data entry workflows provide a highly accurate and customizable to meet any client needs. Below is further information about the SDS QuickClaim data capture subsystems including security components:

Capture Systems

SDS 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 systems:

Optical Character Recognition (OCR): SDS performs OCR to improve quality, reduce cost and shorten turnaround time. NOTE: SDS can now perform OCR on Black & White as well as “red drop” forms.

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 database it is automatically subject to a second review.

Double Key Module: SDS 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.

Audit: SDS 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 the 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.

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.

Rejects Processing Queue: The rejects processing queue 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 the rejects processing queue, we can avoid a reject by identifying the physician name, populating the transaction and resubmitting.

WebKey (Key to 837): This web-based application enables the data entry of claims with subsequent real time conversion to an 837 transaction. WebKey supports Institutional, Professional and Dental transactions. The system presents keyers with a template that mimics the UB, HCFA or Dental form. Once entered, the transaction is automatically validated with any violations presented to the keyers.

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 the transaction modification queue, the client can revise the transaction and resubmit to the PPO for repricing. (This queue can be used for paper or EDI sourced transactions.)

Eligibility Review Queue: This system enables the client to specify conditions in which eligibility matches are reviewed. Typically, the SDS member match 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.

SDS data capture systems are highly secure. Specifically, claim data and claim image files do not leave our Minnesota facilities. (We utilize “thin client” technology.) 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.

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