Enrollment Simplification

Growing their enrollment while reducing dependencies on IT and enrollment staffing is one of the major challenges facing health plans and TPAs today. Smart Data Solutions’ AI powered platform simplifies the integration of 834 files, spreadsheets, and forms, streamlines operations and empowers plans to scale membership quickly and accurately.

Payers face a complex environment:

Before image

Simplify your enrollment process with our AI powered platform:

After image

The platform has a full suite of components to accept, convert, scrub, and deliver the information in the format you need it in.

Platform Components

Form Capture

SDS automates the capture of paper enrollment forms in any layout, including declinations. Forms can be received via mail, fax, or e-mail. You never have to worry about data entry again.

Platform Components

Load Management

Sudden surges of volume can pose challenges for both IT and enrollment staff alike. Annual renewal season can be especially stressful. The enrollment simplification platform can throttle volumes to align with your capacity planning. Additionally, we coordinate data submissions to harmonize renewal volume vs. regular maintenance volume, ensuring you will comfortably meet all your enrollment deadlines.

Platform Components

Full / Change File Conversion

If you are like most payers, you receive a mix of “full data” files and “change only” files. SDS normalizes and consolidates these submissions, so you receive only a single stream in the format that works best for your systems and processes.

Platform Components

File Conversion & Editing

Data streams into our platform from multiple source formats (e.g. 834, CSV, Excel). We convert it and prepare it for submission to you by applying configurable business edits such as:

  • Benefit code crosswalks
  • Rollup/unroll of benefit election codes
  • Automated PCP assignment based on zip code
  • Missing data supplementation

 

Platform Components

Connection Management

Managing multiple data connections with groups and vendors is a major enrollment challenge. It involves technical setup, testing, and ongoing monitoring. The enrollment simplification platform is already connected to a large network of vendors and trading partners, and we handle building out new connections when needed. The result is extremely fast group onboarding and a relieved IT staff.

Platform Components

Data Scheduling

Enrollment data is being submitted 24/7, at varying intervals, and sometimes unexpectedly. Often, payer processes involve manual “drag & drop” of files, posing risks to turn-around times. The enrollment simplification platform automates all transfers and scheduling, so your data is received on time, every time.

Platform Components

Error Detection / Correction

When data problems pop up, they can cause headaches including large amounts of invalid data and pended records in your system. We automatically detect data errors and apply edits to correct invalid data before it reaches you. When manual fixes are required, we provide specialized work queues to enable fast data correction. All of this ensures a clean and accurate enrollment data stream.

Platform Components

Change Detection

Data streams into our platform from multiple source formats. We maintain a complete master copy of your entire enrollment, and we detect changes at an individual field level based on new submissions we receive. This eliminates the work of manually scanning for changes or doing full data reloads.

Platform Components

Form Capture

SDS automates the capture of paper enrollment forms in any layout, including declinations. Forms can be received via mail, fax, or e-mail. You never have to worry about data entry again.

Platform Components

Load Management

Sudden surges of volume can pose challenges for both IT and enrollment staff alike. Annual renewal season can be especially stressful. The enrollment simplification platform can throttle volumes to align with your capacity planning. Additionally, we coordinate data submissions to harmonize renewal volume vs. regular maintenance volume, ensuring you will comfortably meet all your enrollment deadlines.

Platform Components

Full / Change File Conversion

If you are like most payers, you receive a mix of “full data” files and “change only” files. SDS normalizes and consolidates these submissions, so you receive only a single stream in the format that works best for your systems and processes.

Platform Components

File Conversion & Editing

Data streams into our platform from multiple source formats (e.g. 834, CSV, Excel). We convert it and prepare it for submission to you by applying configurable business edits such as:

  • Benefit code crosswalks
  • Rollup/unroll of benefit election codes
  • Automated PCP assignment based on zip code
  • Missing data supplementation

 

Platform Components

Connection Management

Managing multiple data connections with groups and vendors is a major enrollment challenge. It involves technical setup, testing, and ongoing monitoring. The enrollment simplification platform is already connected to a large network of vendors and trading partners, and we handle building out new connections when needed. The result is extremely fast group onboarding and a relieved IT staff.

Platform Components

Data Scheduling

Enrollment data is being submitted 24/7, at varying intervals, and sometimes unexpectedly. Often, payer processes involve manual “drag & drop” of files, posing risks to turn-around times. The enrollment simplification platform automates all transfers and scheduling, so your data is received on time, every time.

Platform Components

Error Detection / Correction

When data problems pop up, they can cause headaches including large amounts of invalid data and pended records in your system. We automatically detect data errors and apply edits to correct invalid data before it reaches you. When manual fixes are required, we provide specialized work queues to enable fast data correction. All of this ensures a clean and accurate enrollment data stream.

Platform Components

Change Detection

Data streams into our platform from multiple source formats. We maintain a complete master copy of your entire enrollment, and we detect changes at an individual field level based on new submissions we receive. This eliminates the work of manually scanning for changes or doing full data reloads.

Focus on What's Important

By letting Smart Data Solutions automate the front-end component of your enrollment intake, your staff can focus on other areas and business needs, including growth. With a flexible solution designed to accommodate the needs of TPAs of all sizes, our platform scales effortlessly to meet your requirements. A user-friendly interface and minimal IT infrastructure requirements, as well as comprehensive support, makes this solution pain-free for you. 

Not only is our solution proven to deliver >30% savings to our clients, the benefits in terms of turnaround time reduction and onboarding time are immense.

 

Download Brochure 
Over 100,000
paper enrollment forms processed monthly
60%
reduction in onboarding time
25%
staff saving
50%
turnaround time reduction
icon

CLIENT STORY

Jeff Bakke

“The partnership with Smart Data Solutions streamlines our enrollment process, allows us to scale and grow more quickly, and ultimately provides the ...”
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

Jeff Bakke

Jeff Bakke
Jeff Bakke
CEO HealthEZ
“The partnership with Smart Data Solutions streamlines our enrollment process, allows us to scale and grow more quickly, and ultimately provides the best experience for our members.”
“The partnership with Smart Data Solutions streamlines our enrollment process, allows us to scale and grow more quickly, and ultimately provides the best experience for our members.”
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

Frequently Asked Questions

Can SDS accept paper enrollment applications?

+
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?

+
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?

+
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?

+
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?

+
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. 

Recent Articles

View All 

Healthcare Cyber-Security: An Urgent Priority and a Shared ...

From casual technology users to CIOs, most people know that data security is a big issue. For many years, we have all been warned ...
Read Article

Smart Data Solutions Appoints Dave Koepke as COO

Eagan, MN, May 30, 2024 — Smart Data Solutions, a leading healthcare process automation company, is pleased to announce a ...
Read Article

Helping Providers Build Resilience and Navigate the ...

It has been a month and still we continue to navigate the aftermath of the recent cyberattack on Change Healthcare. According to ...
Read Article

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

Our tools, solutions, and continued research into new AI and machine learning processes help payers nationwide reduce costs, achieve greater process efficiency, and reduce turnaround times.

Contact Us