Prior Authorization

Prior authorization requirements play an important role in the wise management of medical costs and patient care. However, current processes can be cumbersome, involving high amounts of manual or unnecessary work, which can delay patient care and add cost. With prior authorization volumes rising and pressure from regulatory bodies to streamline PA operations increasing, it’s important for payers to get ahead of the curve and adopt automation and interoperability technology into their workflows.
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Smart Data Solutions' AI-Powered Prior Authorization Solution

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Platform Components

Form Capture

Paper and fax-based prior authorization forms require manual review, data entry, and are often incomplete or filled out inaccurately. Our solution uses OCR and AI to capture form data automatically, eliminating time-consuming data entry.

Platform Components

Medical Chart Summarization

Clinical review can be a costly and time-consuming process due to lengthy medical record submissions. Our AI technology automatically summarizes patient medical records so clinical reviewers can increase their productivity up to 30%.

Platform Components

Rules Engine

Unnecessary PA submissions create needless cost, and many submission decisions can be either partially or fully automated. Our solution allows configuration of your PA submission rules so unnecessary submissions can be reduced or eliminated, and non-complex cases can be decided automatically.

Platform Components

Communication Automation

Traditional PA processes involve too many phone calls, emails, and manual fax handling. We automate communication with provider submitters via portal chat, electronic fax, and synthesized voice calls.

Platform Components

Portal

Most portal solutions offer nothing more than a submission channel, without comprehensive status communication and inventory management. Our portal provides a unique guided experience that ensures complete and accurate submissions, and instantly connects your PA staff with submitting providers for fast communication turn-around.

Platform Components

API

The key to full automation is interoperability with EHR systems, UM tools, claims platforms. What’s more, there are expected upcoming regulations to mandate interoperable capabilities. Our platform is API-ready and provides EHR connectivity via both FHIR and non-FHIR connections.

Platform Components

Form Capture

Paper and fax-based prior authorization forms require manual review, data entry, and are often incomplete or filled out inaccurately. Our solution uses OCR and AI to capture form data automatically, eliminating time-consuming data entry.

Platform Components

Medical Chart Summarization

Clinical review can be a costly and time-consuming process due to lengthy medical record submissions. Our AI technology automatically summarizes patient medical records so clinical reviewers can increase their productivity up to 30%.

Platform Components

Rules Engine

Unnecessary PA submissions create needless cost, and many submission decisions can be either partially or fully automated. Our solution allows configuration of your PA submission rules so unnecessary submissions can be reduced or eliminated, and non-complex cases can be decided automatically.

Platform Components

Communication Automation

Traditional PA processes involve too many phone calls, emails, and manual fax handling. We automate communication with provider submitters via portal chat, electronic fax, and synthesized voice calls.

Platform Components

Portal

Most portal solutions offer nothing more than a submission channel, without comprehensive status communication and inventory management. Our portal provides a unique guided experience that ensures complete and accurate submissions, and instantly connects your PA staff with submitting providers for fast communication turn-around.

Platform Components

API

The key to full automation is interoperability with EHR systems, UM tools, claims platforms. What’s more, there are expected upcoming regulations to mandate interoperable capabilities. Our platform is API-ready and provides EHR connectivity via both FHIR and non-FHIR connections.

Focus on What's Important

The Smart Data Solutions Prior Authorization Platform solves the most common challenges associated with prior authorization workflows including unnecessary or incomplete submissions, manual data entry, and time-consuming clinical reviews.

With an automated and streamlined decision and communication workflow, you’ll improve your member and provider experience greatly.

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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
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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

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

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

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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