Enrollment Solutions

Accepting member enrollment information is labor intensive and error prone. Group enrollment files are often difficult to load, resulting in errors or manual entry. The Smart Data Solutions Benefit Enrollment Maintenance (BEM) Editor eliminates these problems, resulting in automated, accurate, and timely benefit loads.
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Affiliations and Partnerships

Whether you are receiving your enrollments as electronic, paper, or a mix of both, Smart Data Solutions has the tools and solutions needed to accept, scrub, and deliver the information you need in the format you need it in.

Enrollment Solutions

Paper Capture

Enrollment applications come in all shapes and sizes.  Some payers have a single page enrollment form while others may have a 15 page packet.  Regardless of the size, this information needs to be accurately captured and converted to a usable format.  Smart Data Solutions can capture your enrollment forms and can even help you develop new enrollment form layouts to further streamline the process.

Enrollment Solutions

File Format Conversion

Although the 834 is the most commonly used format for this information, many employer groups lack the tools needed to create an 834 themselves.  This results in the groups creating and sending data in whatever format they can. There is seemingly no limit to the different ways enrollment data is submitted by employer groups. Regardless of whether it’s flat files, spreadsheets, CSV files, delimited files, XML, fixed width, or anything else, Smart Data Solutions can accept, consolidate, and deliver the data in a single normalized stream.  

Enrollment Solutions

Full File vs. Change File Conversion

When it comes to full files or change files, at the end of the day, you need to work with the formats your systems are able to accept and process.  No matter if you are receiving full files, change files, or a mix of both, Smart Data Solutions can receive these varied formats and convert to the desired outcome. We can screen full files against prior submitted information, consolidating to just a single change file.  Likewise, we can accumulate information from change files and convert to a regular full file. Regardless of how the information was submitted, you receive exactly what you need as the end result.

Enrollment Solutions

PCP Assignment

Our customized enrollment solutions don’t just stop at converting the applications.  Many of our payers have integrated their Primary Care Provider (PCP) assignment directly into our enrollment process.  Using your business rules along with the location and provider information, Smart Data Solutions can identify the correct PCP and assign it to the member automatically. 

Enrollment Solutions

Paper Capture

Enrollment applications come in all shapes and sizes.  Some payers have a single page enrollment form while others may have a 15 page packet.  Regardless of the size, this information needs to be accurately captured and converted to a usable format.  Smart Data Solutions can capture your enrollment forms and can even help you develop new enrollment form layouts to further streamline the process.

Enrollment Solutions

File Format Conversion

Although the 834 is the most commonly used format for this information, many employer groups lack the tools needed to create an 834 themselves.  This results in the groups creating and sending data in whatever format they can. There is seemingly no limit to the different ways enrollment data is submitted by employer groups. Regardless of whether it’s flat files, spreadsheets, CSV files, delimited files, XML, fixed width, or anything else, Smart Data Solutions can accept, consolidate, and deliver the data in a single normalized stream.  

Enrollment Solutions

Full File vs. Change File Conversion

When it comes to full files or change files, at the end of the day, you need to work with the formats your systems are able to accept and process.  No matter if you are receiving full files, change files, or a mix of both, Smart Data Solutions can receive these varied formats and convert to the desired outcome. We can screen full files against prior submitted information, consolidating to just a single change file.  Likewise, we can accumulate information from change files and convert to a regular full file. Regardless of how the information was submitted, you receive exactly what you need as the end result.

Enrollment Solutions

PCP Assignment

Our customized enrollment solutions don’t just stop at converting the applications.  Many of our payers have integrated their Primary Care Provider (PCP) assignment directly into our enrollment process.  Using your business rules along with the location and provider information, Smart Data Solutions can identify the correct PCP and assign it to the member automatically. 

Focus on What's Important

By outsourcing this front-end component of your enrollment intake your staff can focus on other areas and business needs.  With an Smart Data Solutions hosted data capture solution, there is no need to hire temp workers during your open enrollment periods to handle the incoming surge of applications.  Your analysts will no longer need to convert or enter employee files submitted manually. Eliminating these problem areas help keep you and your staff focused on your core competencies, new products, or additional growth opportunities. 

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Over 100,000
paper enrollment forms processed monthly
7 TONS
of mail per week
400+
Clients
1200+
SOWs written per year

Frequently Asked Questions

Can SDS accept paper enrollment applications?

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x

Yes, SDS processes over 100,000 paper applications monthly for our payers.  We can capture single page forms or packets which may be several pages long.

Can SDS convert data to full files?

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x

Yes, SDS can accumulate information from your change files and create a consolidated change file.

Can SDS convert data to change files?

+
x

Yes, SDS can screen your full files against previous information and distill the changes down to a change file.

Can SDS accept and data from different formats?

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x

Yes, SDS receives and processes enrollment data in a number of different formats:  XML, flat files, spreadsheets, delimited files, CSV files, 834s, and more.

Can SDS detect termination by omission?

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x

Yes, SDS can screen your enrollment submissions against prior data and automatically detect and send terminations for cases where a member is terminated by omission without a formal termination indicator. 

Can SDS assign primary care providers?

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x

Yes, SDS can assign PCPs based on provider information, location information, member demographics, and any other business rules required.

Can SDS apply business rules to verify eligibility prior to enrollment.

+
x

Yes SDS can screen for and flag enrollment applications which are outside of normal enrollment periods, don’t meet age requirements, or may need other evidence of a qualifying life event. 

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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
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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

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

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

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

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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