Claims Operations

Smart Data Solutions is a Business Process Automation (BPA) provider for Health Plans, TPAs, PPOs, and other healthcare entities nationwide. We can enhance staff or outsource workflows related to claims, appeals, enrollments, and other correspondence. Often times we are able to increase efficiency and quality due to our extensive, AI-based automation and the fact that we also perform intake, data capture, and validation functions for those documents and transactions. With our extensive toolset and experience with healthcare payer workflows, we can solve these time-consuming and resource-heavy challenges.

We leverage our multi platform BPA expertise to run more streamlined operations in critical areas of business.

Claims Operations

Examination / Adjudication

With multiple facilities across different countries, we leverage our global claims examining team to deliver increased productivity and real cost savings for our clients. We also have a robust customer-specific training and documentation process that will supplement your staff and allow us to work and handle your various time-consuming workflows. We have the ability to learn and work in your designated queues or incorporate and manage our system in any environment that best works for your business, should you need to make updates or changes.

Claims Operations

Plan Management

Smart Data Solutions has significant experience in configuring adjudication systems to maximize claim payment and in assisting TPAs in plan setup and management.

Claims Operations

Customer Engagement

Smart Data Solutions knows how important it is to improve your turnaround times and get your various collateral processed faster. We offer multiple calling services with flexible service level agreements (SLAs) and strict quality control, removing the burden of specific timeline requirements for your business, including:

  • Calling on misaddressed claims
  • Calling on providers to assist with submission timelines
  • Call and email campaigns to push EDI options to providers

Claims Operations

Provider & Member Matching

Smart Data Solutions knows the importance of streamlining operations to meet specific goals, internal SLAs, and turnaround times. Using machine learning integrations, we have developed algorithms to aid in validating and cleaning data as it passes through QuickClaim, our proprietary workflow interface. With our customized algorithms and interfaces, developed specifically for matching, any workflow or process can be easily streamlined, saving valuable time and resources.

Claims Operations

Examination / Adjudication

With multiple facilities across different countries, we leverage our global claims examining team to deliver increased productivity and real cost savings for our clients. We also have a robust customer-specific training and documentation process that will supplement your staff and allow us to work and handle your various time-consuming workflows. We have the ability to learn and work in your designated queues or incorporate and manage our system in any environment that best works for your business, should you need to make updates or changes.

Claims Operations

Plan Management

Smart Data Solutions has significant experience in configuring adjudication systems to maximize claim payment and in assisting TPAs in plan setup and management.

Claims Operations

Customer Engagement

Smart Data Solutions knows how important it is to improve your turnaround times and get your various collateral processed faster. We offer multiple calling services with flexible service level agreements (SLAs) and strict quality control, removing the burden of specific timeline requirements for your business, including:

  • Calling on misaddressed claims
  • Calling on providers to assist with submission timelines
  • Call and email campaigns to push EDI options to providers

Claims Operations

Provider & Member Matching

Smart Data Solutions knows the importance of streamlining operations to meet specific goals, internal SLAs, and turnaround times. Using machine learning integrations, we have developed algorithms to aid in validating and cleaning data as it passes through QuickClaim, our proprietary workflow interface. With our customized algorithms and interfaces, developed specifically for matching, any workflow or process can be easily streamlined, saving valuable time and resources.

Leveraging Automation from End-to-End

At Smart Data Solutions, we continuously asses and applies automation solutions in lieu of labor to improve quality and reduce re-work, leading to increasing overall efficiency. We focus on achieving materially higher auto adjudication rates and implementing continuous improvement programs leveraging process and technology innovation to exceed and maintain high service standards.

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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
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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

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

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

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

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

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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.

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