OCR / Data Capture

With over 20 years of experience and over 370 implementations, we’ve helped many health plans, TPAs, PPOs, and other healthcare organizations streamline their front-end intake processes. Often times front-end processes are costly to manage, have high turnover, process inefficiencies, and have little transparency. Smart Data Solutions applies technological solutions in lieu of labor to streamline the mailroom and conversion processes. This approach increases quality levels and provides the transparency needed to manage and improve operations. Our streamlining and automation has saved organizations upwards of 80% while providing a complete solution to the front-end headaches.
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Affiliations and Partnerships

Smart Data Solutions performs data capture on over 2 million claims, correspondence documents, and other non-standard forms each month.

OCR / Data Capture

Conversion Workflow

Today’s mailroom volume requires better identification tools, a clearly defined capture spec for each document type, and a logical workflow procedure per doc type. 15 years ago, single page claims were 85% of a mailroom’s volume. Now 85% of mailroom volume is claims-with-attachments, and non-standard documents (appeals, medical records, correspondence etc.). Smart Data Solutions incorporates artificial intelligence, hardware, and software solutions, streamlining the entire mailroom intake and front-end process. We invite you to come tour one of our Twin Cities mailroom locations to see how claims, EOBs, attachments, X-rays, appeals, receipts, attachments, faxes, emails, medical records, Medicaid forms etc. are processed.

OCR / Data Capture

Quality Control

While rejects or issues can happen anywhere, detecting them as far forward in the process as possible streamlines all downstream workflow saving time, money, and increases overall efficiency. At Smart Data Solutions, we look at all possible reject-points in the workflow and establish review queues for your analysts to review and handle the pieces that reject.

Smart Data Solutions’ integrated rejection and fallout queues provide tools and solutions which allow your analysts to:

  • Review documents which fail EDI compliance screening or business rules.
  • Correct or update rejected documents, releasing them back into the processing workflow.
  • Reject a claim back to a provider by issuing a rejection letter citing the reason for the rejection and the re-submission instructions.

OCR / Data Capture

Member Matching

Member related issues continue to be one of the leading causes of rejections for many payers. These discrepancies can consume lots of resources on both the payer and provider side. Member identification issues lead to time spent by your analysts reviewing claims, your service reps responding to provider questions and ultimately all of the additional work required to process the claim again once it’s resubmitted. Our inline member validation processes compare claims against your member extracts, validating and cleaning the data as it passes through our system. We are able to identify the patients and subscribers, validate that the members had active coverage for the dates of service, and identify any PPO affiliations to begin the repricing processes. All of this data is then cleaned and normalized into the exact formats your system expects, reducing your pends and increasing your auto-adjudication rates.

OCR / Data Capture

Provider Matching and Cleanup

Identifying, tracking, and managing provider records can be a challenge for many payers. Issues such as minor variations in a provider’s name or address could potentially create dozens of duplicate records, which may lead to billing problems, payment problems, or complications filing tax information. Ultimately, all of this can lead to confusion, frustration, and potentially a large amount of extra work. By screening claims against your provider extracts, or the NPI database, Smart Data Solutions is able to ensure that the provider information we send matches the records in your system, eliminating duplication issues. When a new provider is detected, our system identifies these cases and notifies your analysts allowing you to create the provider record the way you want it.

OCR / Data Capture

Audits and Reporting

We know how important SLAs and tracking metrics are to managing your production volume. These statistics provide you with the peace of mind to know that your quality standards, TAT, and response times are all within contractual limits. To that end, our QuickClaim web portal is a fully transparent window into our processes, showing you where your documents are every step of the way. Additionally, we provide integrated reports and email alerts at the intervals needed by you and your team allowing you address issues before they become problems.

OCR / Data Capture

Conversion Workflow

Today’s mailroom volume requires better identification tools, a clearly defined capture spec for each document type, and a logical workflow procedure per doc type. 15 years ago, single page claims were 85% of a mailroom’s volume. Now 85% of mailroom volume is claims-with-attachments, and non-standard documents (appeals, medical records, correspondence etc.). Smart Data Solutions incorporates artificial intelligence, hardware, and software solutions, streamlining the entire mailroom intake and front-end process. We invite you to come tour one of our Twin Cities mailroom locations to see how claims, EOBs, attachments, X-rays, appeals, receipts, attachments, faxes, emails, medical records, Medicaid forms etc. are processed.

OCR / Data Capture

Quality Control

While rejects or issues can happen anywhere, detecting them as far forward in the process as possible streamlines all downstream workflow saving time, money, and increases overall efficiency. At Smart Data Solutions, we look at all possible reject-points in the workflow and establish review queues for your analysts to review and handle the pieces that reject.

Smart Data Solutions’ integrated rejection and fallout queues provide tools and solutions which allow your analysts to:

  • Review documents which fail EDI compliance screening or business rules.
  • Correct or update rejected documents, releasing them back into the processing workflow.
  • Reject a claim back to a provider by issuing a rejection letter citing the reason for the rejection and the re-submission instructions.

OCR / Data Capture

Member Matching

Member related issues continue to be one of the leading causes of rejections for many payers. These discrepancies can consume lots of resources on both the payer and provider side. Member identification issues lead to time spent by your analysts reviewing claims, your service reps responding to provider questions and ultimately all of the additional work required to process the claim again once it’s resubmitted. Our inline member validation processes compare claims against your member extracts, validating and cleaning the data as it passes through our system. We are able to identify the patients and subscribers, validate that the members had active coverage for the dates of service, and identify any PPO affiliations to begin the repricing processes. All of this data is then cleaned and normalized into the exact formats your system expects, reducing your pends and increasing your auto-adjudication rates.

OCR / Data Capture

Provider Matching and Cleanup

Identifying, tracking, and managing provider records can be a challenge for many payers. Issues such as minor variations in a provider’s name or address could potentially create dozens of duplicate records, which may lead to billing problems, payment problems, or complications filing tax information. Ultimately, all of this can lead to confusion, frustration, and potentially a large amount of extra work. By screening claims against your provider extracts, or the NPI database, Smart Data Solutions is able to ensure that the provider information we send matches the records in your system, eliminating duplication issues. When a new provider is detected, our system identifies these cases and notifies your analysts allowing you to create the provider record the way you want it.

OCR / Data Capture

Audits and Reporting

We know how important SLAs and tracking metrics are to managing your production volume. These statistics provide you with the peace of mind to know that your quality standards, TAT, and response times are all within contractual limits. To that end, our QuickClaim web portal is a fully transparent window into our processes, showing you where your documents are every step of the way. Additionally, we provide integrated reports and email alerts at the intervals needed by you and your team allowing you address issues before they become problems.

Complete Data Capture Solutions

While some capture providers only offer turnkey OCR based solutions, Smart Data Solutions goes far beyond to provide a holistic multi-faceted approach to your front-end capture needs. Smart Data Solutions leverages multiple technologies and data capture best practices such as OCR, double blind data verification, integrated quality control checks, member validation, provider validation, ICD-10, NPI, CPT, and other code set validation. These data reads and validation processes are further augmented by EDI validation and business rule pre-checks which identify any missing, invalid, or otherwise erroneous submissions. All of these processes work together to capture and validate as much information as possible from your claims and correspondence documents.

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2M
STANDARD CLAIM FORMS PER MONTH
400K
NON-STANDARD/CORRESPONDENCE DOCUMENTS PER MONTH
80K
ENROLLMENT APPLICATIONS PER MONTH
>99.5%
accuracy

Frequently Asked Questions

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

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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.

Can Smart Data handle EOB attachments?

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Yes, SDS processes many EOB attachments for clients. We will capture the primary payer information off the EOB, and populate the COB loop / CAS segments in the 837.

How does SDS run quality control checks on all claims?

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As part of the standard workflow, SDS runs QC on all claims. Below are some examples:

  • Balancing check to ensure lines being billed add up to total amount billed
  • Client specific business rules are enforced
  • Ensuring all CPT codes are valid codes
  • Ensuring all data meets expected format for that field
  • NPI database check

Claims that do not pass QC are flagged for review and a SDS staff will verify our data entry read and make corrections if needed

What types of edits and reject conditions are in place? Does SDS work off a base edit and reject conditions template?

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Yes, SDS starts with our standard edits and reject conditions for each form type. Please keep in mind this is just a start, though. We ultimately implement edits and reject conditions per client requirements and per client adjudication system. We can loosen or tighten reject conditions as clients see fit. This part of the process is determined during testing. Our framework enables rapid development of custom edits.

Will we have the ability to review claims in question to determine next steps?

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x

Yes, claims will run through rejection screening where we will check for a complete claim, business rules applied, format validation, etc. If there are any errors found, SDS will review to ensure there are no data capture errors. If there were no capture errors, the claim will go to a client review queue where the client can input the needed information and get the claim back into the workflow, or, can reject the claim back to the provider.

What is member match and how does it help with eligibility criteria analysis?

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Member match enables fully automated, sophisticated eligibility matching that ensures an accurate match. Then, once the match is made the associated “backfill” and routing are executed prior to export.

We use robust testing methodology to ensure the eligibility matching accuracy of our automated processes exceeds that of existing manual processes.

Our system enables the client to specify conditions in which eligibility matches are reviewed.

Does SDS perform Provider File Matching and have a PFM system?

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Our provider file matching is a complex system that uses a weighted combination of string comparison algorithms, a modular design and “process of elimination” approach to tease out the corresponding provider in your database. Our current match rate statistics for clients utilizing provider file matching is 100%. This is achieved through regular provider file updates and proper claims data.

Does SDS provide portals for multiple user groups?

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SDS provides member, employee, and provider portals in which users are able to view benefit info, co-pay coverage, SPPs, Request ID cards, view announcements and other related data services. SDS portals provide lower costs, less administration, high member satisfaction and custom branding.

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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 ...”
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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
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.”
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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.”
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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.”
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