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Interoperability

Companies need to simplify their environment by reducing the number of connections they maintain. They must leverage AI and automation to derive value from the data they exchange, not just pass it through. They must have clear tracking and transparency to all of their connections and interactions and should leverage interoperability to provide a more complete member experience and engagement.

Smart Data Solutions connects over 1000 partners, 400 payers and 30 adjudication platforms.

Enrollment Simplification Tiered Network Pricing Pharmacy Benefit Management DE Medicare Crossover Interoperability

Interoperability

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.

Interoperability

Tiered Network Pricing

Rules-based hierarchical routing engine that manages routing claims to primary networks, secondary networks and cost-containment vendors prior to loading claims into the payer’s adjudication platform.

Interoperability

Pharmacy Benefit Management DE

This interoperability solution provides accelerated connectivity between payers and Pharmacy Benefit Managers (PBM) and facilitates scheduling, data formatting, reconciliation of eligibility, accumulator and prescription claim data.

Interoperability

Medicare Crossover Interoperability

This is an interoperability solution connecting TPAs that provide Medicare supplementary coverage with CMS to facilitate the exchange and reconciliation of enrolment and claims data.

Interoperability

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.

Interoperability

Tiered Network Pricing

Rules-based hierarchical routing engine that manages routing claims to primary networks, secondary networks and cost-containment vendors prior to loading claims into the payer’s adjudication platform.

Interoperability

Pharmacy Benefit Management DE

This interoperability solution provides accelerated connectivity between payers and Pharmacy Benefit Managers (PBM) and facilitates scheduling, data formatting, reconciliation of eligibility, accumulator and prescription claim data.

Interoperability

Medicare Crossover Interoperability

This is an interoperability solution connecting TPAs that provide Medicare supplementary coverage with CMS to facilitate the exchange and reconciliation of enrolment and claims data.

Focus on What's Important

The Smart Data Solutions’ Interoperability platform enables streamlined process and workflows between multiple trading partners. Our intelligent document management transformation service gives you your data in your format, isolating you from the ever changing partner’s data and format. You will be provided visibility and auditability through our strong reporting and dashboard tools for full end to end transparency.

We leverage our AI, workflow and automation to identify and resolve issues to deliver best in class service levels and we invest heavily in data protection and HIPAA HITRUST ensuring your data is never at risk.

1,000+
Industry partners
More than 400
Payer connections
30+
Adjudication platforms
800,000
Transactions per month
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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
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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

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?

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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