EDI / Clearinghouse

Front-end EDI clearinghouse solutions fulfill a vital role in today's healthcare space. A good clearinghouse allows for seamless data exchange between you and your provider networks. This integration gives providers the tools and access necessary to submit, receive, and request information from different systems. Well run clearinghouse operations will reduce both paper submissions and call center traffic, providing your physicians with the information and services they need.
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Affiliations and Partnerships

Smart Data Stream processes over 500M transactions annually.

EDI / Clearinghouse

Provider Portal

Our easy to use portal gives providers access to the services and information they need and use on a daily basis. The portal allows providers access to both our par and non-par payer lists, allowing them to submit to nearly all payer destinations. 835 data can be viewed and processed through our portal serving as a vital link in the revenue cycle management (RCM) process. Eligibility and claim status requests are clean and straightforward through our simple search interfaces. All of these services provide a comprehensive set of tools allowing providers to submit and retrieve information from payers quickly.

EDI / Clearinghouse

Claims Intake

Smart Data Solutions offers connections to both our par and non-par payer lists allowing for easy access to a wide array of payers. If a provider has a practice management system capable of producing 837s, they can be dragged and dropped into a simple upload web interface, or for high volume submissions, regular FTP exchanges can be configured to fully automate the process. If 837 creation is not possible for a physician, our interface allows a provider to enter claim information directly into the web portal just like filling out a standard claim form. Additionally, the portal allows providers to save claim templates allowing the ability to create common claim forms easily by loading the template and updating the date and patient information.

EDI / Clearinghouse

835 Response

Smart Data Solutions offers 835 destination routing, allowing providers to choose their remittance destination. These transactions can be directed to a provider’s RCM system, others clearinghouse destinations, or can be displayed within the portal as an easy to read and understand explanation of payment (EOP).

EDI / Clearinghouse

Real Time Transactions

The portal allows easy access into connected payers’ real time information systems. Our Provider Portal has claim status and eligibility interfaces which allow providers to quickly get the information they need on demand without having to phone in requests. This information is in a clean and straightforward display for the provider and the back-end connections fulfill the requests over the CAQH CORE 270/271 and 276/277 protocols, maintaining compliance with the real-time information request mandates.

EDI / Clearinghouse

HL7 FHIR Solutions

In today’s ever-changing environment being able to send information in real-time has become crucial. With the use of FHIR, you will now be able to send non-claim information quickly, without sacrificing information integrity. Smart Data Solutions has the ability to implement a workflow using FHIR, allowing you to receive your most relevant data quickly and in a streamlined format, all while integrating with other SDS services.

Solutions SDS can offer:

  • Checking to see if a patient is in a payer’s FHIR database
  • Connecting to a payer’s FHIR database to confirm information about a provider
  • Having the ability to easily flag when services rendered on a claim don’t match what’s expected

EDI / Clearinghouse

Provider Portal

Our easy to use portal gives providers access to the services and information they need and use on a daily basis. The portal allows providers access to both our par and non-par payer lists, allowing them to submit to nearly all payer destinations. 835 data can be viewed and processed through our portal serving as a vital link in the revenue cycle management (RCM) process. Eligibility and claim status requests are clean and straightforward through our simple search interfaces. All of these services provide a comprehensive set of tools allowing providers to submit and retrieve information from payers quickly.

EDI / Clearinghouse

Claims Intake

Smart Data Solutions offers connections to both our par and non-par payer lists allowing for easy access to a wide array of payers. If a provider has a practice management system capable of producing 837s, they can be dragged and dropped into a simple upload web interface, or for high volume submissions, regular FTP exchanges can be configured to fully automate the process. If 837 creation is not possible for a physician, our interface allows a provider to enter claim information directly into the web portal just like filling out a standard claim form. Additionally, the portal allows providers to save claim templates allowing the ability to create common claim forms easily by loading the template and updating the date and patient information.

EDI / Clearinghouse

835 Response

Smart Data Solutions offers 835 destination routing, allowing providers to choose their remittance destination. These transactions can be directed to a provider’s RCM system, others clearinghouse destinations, or can be displayed within the portal as an easy to read and understand explanation of payment (EOP).

EDI / Clearinghouse

Real Time Transactions

The portal allows easy access into connected payers’ real time information systems. Our Provider Portal has claim status and eligibility interfaces which allow providers to quickly get the information they need on demand without having to phone in requests. This information is in a clean and straightforward display for the provider and the back-end connections fulfill the requests over the CAQH CORE 270/271 and 276/277 protocols, maintaining compliance with the real-time information request mandates.

EDI / Clearinghouse

HL7 FHIR Solutions

In today’s ever-changing environment being able to send information in real-time has become crucial. With the use of FHIR, you will now be able to send non-claim information quickly, without sacrificing information integrity. Smart Data Solutions has the ability to implement a workflow using FHIR, allowing you to receive your most relevant data quickly and in a streamlined format, all while integrating with other SDS services.

Solutions SDS can offer:

  • Checking to see if a patient is in a payer’s FHIR database
  • Connecting to a payer’s FHIR database to confirm information about a provider
  • Having the ability to easily flag when services rendered on a claim don’t match what’s expected

Resources

Smart Data Solutions integrates with payers and providers nationwide, offering a host of solutions to make clearinghouse connections easier.

 

Payer List
Sign up for Provider Portal
Provider Portal Guide
Get Started 
9,200
Connections
500M
Transactions annually
200,000
Provider connections
Over $1 Billion
in transaction billing per month

Frequently Asked Questions

If I terminate my current clearinghouse and migrate to SDS, will rejected claims that get sent to my current clearinghouse be dropped to paper? How does SDS manage this?

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x

For a short period of time (1 month after go-live) some claims could be dropped to paper and mailed to SDS. SDS will designate a PO Box for these claims, and perform OCR/data capture to convert to 837. SDS will also perform outreach in conjunction with the payer to identify the providers that have fallen through the cracks and continue to submit EDI to the wrong clearinghouse. Through outreach efforts, we eventually get all providers to submit EDI correctly, thus, eliminating EDI claims that get rejected at clearinghouses and drop to paper.

What are Smart Data Solutions and Smart Data Stream’s quality control measures?

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Smart Data Stream’s quality control edits fall into the following three categories:

  • Data Integrity Edits: Used to “tease out” data entry errors. For example, if the billing “from date” is after the “to date” the claim is subject to a second review.
  • Transformation Edits: This includes items such as name parsing and conversion from minutes to units for anesthesiology claims.
  • EDI Compliance Edits: This includes enforcement of EDI rules. For example, on a UB an occurrence code must be accompanied by an occurrence date.

What clearinghouse/EDI products and services does Smart Data Stream offer?

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  • Provider Outreach to Increase Electronic Adoption
  • Electronic Claims Processing
  • 275 Electronic Attachment Submission
  • Referrals and Authorizations
  • Electronic Remittance Advice (ERA)
  • 835 EFT Processing
  • Workers Comp and eBills
  • Medicare Med-Sup Cross Connect
  • 270 / 271 Eligibility Inquiries
  • 276 / 277 Claim Status
  • Provider File Matching 
  • Member Matching 
  • Duplicate Checking
  • Image Archive and Retrieval
  • EDI Conversion and Management
  • Direct Connections
  • Cost Containment Connectivity
  • CMS Mandatory Insurer Reporting 
  • FHIR Solutions

What file extracts does SDS need from the payer to begin implementing CORE compliance transactions?

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x

270/271: There are 3 extracts files for this transaction

  • Eligibility Demographic Data Record
    • Provides information regarding eligible members and the plan(s) in which they are enrolled
  • Plan Benefit Data Record
    • Provides information regarding specific benefit and patient responsibility amounts for each plan
    • The eligibility and plan benefit files are tied together by the plan identifier
  • Individual Benefit Data Record
    • Provides accumulator amounts for an individual’s remaining deductible under a given plan
    • The plan identifier and unique member identifier are used to tie this record to the other two extracts

276/277: There is only 1 extract file for this transaction

  • Typically, the payer claim control number is used to group records in this file

What types of form types and non-claim documents do you support?

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x

Smart Data Solutions can support a wide variety of claim and non-claim document types for your business. If you do not see your document type on this list, don’t hesitate to reach out and ask. It is rare that we cannot find a solution for your unique document type.

  • Medical Claims
  • Dental Claims
  • Rx Claims
  • Non-Standard Claims
  • Secondary Claims (EOB/EOMB)
  • Flexible Spending Account
  • Reimbursements
  • Roster Billing
  • Enrollment Applications
  • Superbills
  • Member reimbursements
  • Request for payments
  • Medicaid Reclamation

What types of transactions does Smart Data support?

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x
  • 837 P, I, D
  • Work comp EDI bills
  • CAQH CORE transactions (270,271 & 276,277)
  • 835 ERA
  • 834 Enrollment / Eligibility
  • 275 eAttachment
  • 278 Prior-Authorization
  • 820 Premium Payment
  • 999 Acknowledgement
  • FHIR

Who Owns the Payer ID?

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The payer does. The payer ID determines destination routes and where claims are to be sent. The clearinghouse does not own the payer ID.

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CLIENT TESTIMONY

Debbie Ziegler

“SDS performs all of our front-end services. This includes clearinghouse, scanning, imaging, OCR and mailroom. SDS also facilitates and performs ...”
View Story
icon

CLIENT TESTIMONY

Brian Janssen

“Smart Data operates as the EDI clearinghouse, paper claims and enrollment intake, and 834 enrollment hub for our commercial products. The development ...”
View Story
icon

CLIENT TESTIMONY

Matthew Estes

“SDS does EDI file translation mapping, eligibility checking, and routing to/from our business partners. SDS handles a lot of the heavy lifting for us ...”
View Story

CLIENT TESTIMONY

Debbie Ziegler

Executive Director of Operations
“SDS performs all of our front-end services. This includes clearinghouse, scanning, imaging, OCR and mailroom. SDS also facilitates and performs automated routing to PPOs and networks, thereby ensuring that we expediently maximize client discounts. SDS also does pre-adjudication edits, such as member and provider matching. Finally, SDS provides custom IT services such as file format conversion and transfer for our Amerihealth and BCI partnership claims. SDS has a comprehensive service suite thereby allowing “one-stop shopping’ for all our front-end services. This is both cost-effective and much easier to manage. In addition, their IT aptitude allows us to fill in the gaps for one-off type projects. The process runs smoothly without much intervention. When we do have an issue they are quick to respond with a solution.”
“SDS performs all of our front-end services. This includes clearinghouse, scanning, imaging, OCR and mailroom. SDS also facilitates and performs automated routing to PPOs and networks, thereby ensuring that we expediently maximize client discounts. SDS also does pre-adjudication edits, such as member and provider matching. Finally, SDS provides custom IT services such as file format conversion and transfer for our Amerihealth and BCI partnership claims. SDS has a comprehensive service suite thereby allowing “one-stop shopping’ for all our front-end services. This is both cost-effective and much easier to manage. In addition, their IT aptitude allows us to fill in the gaps for one-off type projects. The process runs smoothly without much intervention. When we do have an issue they are quick to respond with a solution.”
View Solution

CLIENT TESTIMONY

Brian Janssen

VP, System Solutions
“Smart Data operates as the EDI clearinghouse, paper claims and enrollment intake, and 834 enrollment hub for our commercial products. The development and execution of these solutions is always done partnered with the business leaders to ensure meaningful improvements are achieved. Because of that, Smart Data is considered a valuable partner by business leaders. When we start a Smart Data initiative, as a corporate leader I do not have to worry about whether the outcome will be successful.”
“Smart Data operates as the EDI clearinghouse, paper claims and enrollment intake, and 834 enrollment hub for our commercial products. The development and execution of these solutions is always done partnered with the business leaders to ensure meaningful improvements are achieved. Because of that, Smart Data is considered a valuable partner by business leaders. When we start a Smart Data initiative, as a corporate leader I do not have to worry about whether the outcome will be successful.”
View Solution

CLIENT TESTIMONY

Matthew Estes

Chief Information Officer
“SDS does EDI file translation mapping, eligibility checking, and routing to/from our business partners. SDS handles a lot of the heavy lifting for us and allows us to focus on what we do best. No matter how complex the setup and routing, SDS has always been able to make it work for us.”
“SDS does EDI file translation mapping, eligibility checking, and routing to/from our business partners. SDS handles a lot of the heavy lifting for us and allows us to focus on what we do best. No matter how complex the setup and routing, SDS has always been able to make it work for us.”
View Solution

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