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. Oftentimes 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 capabilities has saved organizations upwards of 80% while providing a complete solution to the front-end headaches.
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AI- Powered Data Capture Processes

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

Data Capture

Data Capture Automation

Smart Data Solutions incorporates artificial intelligence, hardware, and software solutions, streamlining the entire mailroom intake and data capture process.

We utilize four independent OCR systems through which all documents are passed through twice. Based on pre-established confidence levels, if there is disagreement on the capture fields after two passes, the field is processed through our unique ‘Smartzone snippets’ data verification system.

We continue to monitor and curate our OCR and Machine Learning Models to provide the highest possible accuracy.

Data Capture

Actioning: Member Matching

Member-related issues continue to be one of the leading causes of rejections for 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 is resubmitted. Our inline member validation processes compare claims against your member extracts, validating and cleaning the data as it passes through our AI platform. 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 data is then cleaned and normalized into the exact formats your system expects, reducing your pends and increasing your auto-adjudication rates.

We will configure edits and process rules that will automate rejected documents and reduce the need for manual intervention and review.

Data Capture

Actioning: Provider Matching

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 AI platform identifies these cases and notifies your analysts allowing you to create the provider record the way you want it.

Data Capture

Actioning: Client Specific Edits

Smart Data Solutions transforms and delivers your data based on our ability to apply client-specific edits, leveraging our extensive library of healthcare edits.

This customized editing process allows for the application of client workflows and data validation prior to export. We will apply the edits to identify missing, invalid data or errors and correct the data to ensure valid data sets.

Our objective is to deliver clean data files to enhance the auto-adjudication process.

Data Capture

Reject Handling

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 that 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.

Data Capture

Transform and Deliver

Smart Data Solution uses an automated rules engine, to transform the various data formats into the file format specified by the client and then deliver this to the client electronically.

We export files to clients in various formats which include 837, NCPDP, CSV, JSON and XML.

Our workflow queues allow clients to perform key tasks within QuickClaim before the exporting of documents.  This allows for an upstream process that improves overall auto-adjudication.

Data Capture

End-to-end transparency

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 to address issues before they become problems.

Moreover, Smart Data Solutions performs consistent and continual auditing of all documents processed. The audits review data at the field level and can tie the information back to a manual keyer or OCR model. The audited information is reported regularly to clients with full transparency.

Data Capture

Data Capture Automation

Smart Data Solutions incorporates artificial intelligence, hardware, and software solutions, streamlining the entire mailroom intake and data capture process.

We utilize four independent OCR systems through which all documents are passed through twice. Based on pre-established confidence levels, if there is disagreement on the capture fields after two passes, the field is processed through our unique ‘Smartzone snippets’ data verification system.

We continue to monitor and curate our OCR and Machine Learning Models to provide the highest possible accuracy.

Data Capture

Actioning: Member Matching

Member-related issues continue to be one of the leading causes of rejections for 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 is resubmitted. Our inline member validation processes compare claims against your member extracts, validating and cleaning the data as it passes through our AI platform. 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 data is then cleaned and normalized into the exact formats your system expects, reducing your pends and increasing your auto-adjudication rates.

We will configure edits and process rules that will automate rejected documents and reduce the need for manual intervention and review.

Data Capture

Actioning: Provider Matching

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 AI platform identifies these cases and notifies your analysts allowing you to create the provider record the way you want it.

Data Capture

Actioning: Client Specific Edits

Smart Data Solutions transforms and delivers your data based on our ability to apply client-specific edits, leveraging our extensive library of healthcare edits.

This customized editing process allows for the application of client workflows and data validation prior to export. We will apply the edits to identify missing, invalid data or errors and correct the data to ensure valid data sets.

Our objective is to deliver clean data files to enhance the auto-adjudication process.

Data Capture

Reject Handling

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 that 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.

Data Capture

Transform and Deliver

Smart Data Solution uses an automated rules engine, to transform the various data formats into the file format specified by the client and then deliver this to the client electronically.

We export files to clients in various formats which include 837, NCPDP, CSV, JSON and XML.

Our workflow queues allow clients to perform key tasks within QuickClaim before the exporting of documents.  This allows for an upstream process that improves overall auto-adjudication.

Data Capture

End-to-end transparency

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 to address issues before they become problems.

Moreover, Smart Data Solutions performs consistent and continual auditing of all documents processed. The audits review data at the field level and can tie the information back to a manual keyer or OCR model. The audited information is reported regularly to clients with full transparency.

Quality First

Quality is the highest priority during the capture process. Through the automation process, Smart Data Solutions is able to apply over 1000 proprietary edits which assist with Auto-correction, Auto-Validation and Referential Data Comparison to ensure the highest level of quality and accuracy in the data for export to the client. We utilize a double key capture process in which all documents are processed through the OCR models twice to ensure field level corroboration. If the fields do not match, snippets of just the field in question are sent for manual review in a double blind manner. This process cascades until a high confidence is reached, providing for the highest possible accuracy.

2M
STANDARD CLAIM FORMS PER MONTH
500K
NON-STANDARD/CORRESPONDENCE DOCUMENTS PER MONTH
100K
ENROLLMENT APPLICATIONS PER MONTH
>99.5%
accuracy
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CLIENT STORY

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 STORY

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 STORY

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

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

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

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

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