Blues Organizations

With over 20 years of experience and dozens of Blues clients, Smart Data Solutions understands what solutions are most helpful and relevant to your organization. SDS has the know-how and expertise in healthcare process automation, providing your organization with scalable solutions capable of handling large claim volumes and complex projects that are compatible with any necessary business requirements.

Smart Data Solutions works with 15 Blues Organizations nationwide.

Blues Organizations

Data Capture Automation

Smart Data Solutions’ proprietary data capture automation technology offers the highest level of automation possible with the ability to capture data from all types of paper documents and convert them to structured data formats. Our technology uses patient demographic data, dates, procedure/diagnosis codes, COBs, attachments, and other referential data and feeds it into our proprietary framework made up of 4 different OCR engines, deep learning, Convolutional Neural Network Models (UNET), and statistical models to provide the best possible data capture automation solutions. We have achieved a 99% OCR rate with these technologies, improved turnaround times, and approximately 99.95% field-level accuracy.

Blues Organizations

Appeals Processing

We know that processing appeals is unlike other correspondence and therefore can be more difficult to manage. With varying jurisdictions and turnaround times, processing can become convoluted. Smart Data Solutions can help to automate the categorization of all correspondence, including appeals.

We can automate the identification of appeals from other healthcare correspondence. Identifying the referenced member as well as the claim or authorization can be done through the use of member data, provider data, claim history, submitter ID, eligibility extracts, and image features. Our machine learning models and algorithms make appeals processing far more manageable, with an overall 99.7% accuracy rate.

Once the appeals are quickly identified, we can capture the other pertinent information and supply that in a workflow queue for your team to work on. We also have the ability to identify specific keywords and support decision-making, streamlining the overall manual review process.

Blues Organizations

Federal Employee Program

Having already worked with dozens of Blues organizations, we can easily help you to automate and streamline your healthcare data by adopting our digital mailroom and integrating data management programs. Smart Data Solutions works with Federal Employee Program (FEP) customers and understands the differences between FEP and commercial healthcare, such as proprietary processing systems and required turnaround times.

Once we identify these FEP-specific claims, we are able to process them with the differentiating business rules that are established and push them to a workflow queue to be worked or exported directly to your system in the format that works best for your team.

Blues Organizations

Prior Authorizations

Smart Data Solutions can streamline prior authorization clinical review and decision support using medical record data extraction, relevant data summarization, and predictive decision support. This decision process requires standard information across the industry typically found in a medical record.

Smart Data Solutions has created a proprietary medical records indexing workflow, making it easier to find the data you need while removing what you don’t. This process can be further enhanced by customization, like approval and denial scenarios.

After intake, we perform standard machine learning processing tasks such as tokenization and stop word removal. At this step, we also gather and analyze industry-related referential data. But to further aid this process we have also created algorithms that provide complex configurations to optimize any specific client requirements needed.

With this technology, your organization will achieve faster and more accurate prior authorization decisions, as well as an increase in throughput and a reduction in backlogged authorizations.

Blues Organizations

Data Capture Automation

Smart Data Solutions’ proprietary data capture automation technology offers the highest level of automation possible with the ability to capture data from all types of paper documents and convert them to structured data formats. Our technology uses patient demographic data, dates, procedure/diagnosis codes, COBs, attachments, and other referential data and feeds it into our proprietary framework made up of 4 different OCR engines, deep learning, Convolutional Neural Network Models (UNET), and statistical models to provide the best possible data capture automation solutions. We have achieved a 99% OCR rate with these technologies, improved turnaround times, and approximately 99.95% field-level accuracy.

Blues Organizations

Appeals Processing

We know that processing appeals is unlike other correspondence and therefore can be more difficult to manage. With varying jurisdictions and turnaround times, processing can become convoluted. Smart Data Solutions can help to automate the categorization of all correspondence, including appeals.

We can automate the identification of appeals from other healthcare correspondence. Identifying the referenced member as well as the claim or authorization can be done through the use of member data, provider data, claim history, submitter ID, eligibility extracts, and image features. Our machine learning models and algorithms make appeals processing far more manageable, with an overall 99.7% accuracy rate.

Once the appeals are quickly identified, we can capture the other pertinent information and supply that in a workflow queue for your team to work on. We also have the ability to identify specific keywords and support decision-making, streamlining the overall manual review process.

Blues Organizations

Federal Employee Program

Having already worked with dozens of Blues organizations, we can easily help you to automate and streamline your healthcare data by adopting our digital mailroom and integrating data management programs. Smart Data Solutions works with Federal Employee Program (FEP) customers and understands the differences between FEP and commercial healthcare, such as proprietary processing systems and required turnaround times.

Once we identify these FEP-specific claims, we are able to process them with the differentiating business rules that are established and push them to a workflow queue to be worked or exported directly to your system in the format that works best for your team.

Blues Organizations

Prior Authorizations

Smart Data Solutions can streamline prior authorization clinical review and decision support using medical record data extraction, relevant data summarization, and predictive decision support. This decision process requires standard information across the industry typically found in a medical record.

Smart Data Solutions has created a proprietary medical records indexing workflow, making it easier to find the data you need while removing what you don’t. This process can be further enhanced by customization, like approval and denial scenarios.

After intake, we perform standard machine learning processing tasks such as tokenization and stop word removal. At this step, we also gather and analyze industry-related referential data. But to further aid this process we have also created algorithms that provide complex configurations to optimize any specific client requirements needed.

With this technology, your organization will achieve faster and more accurate prior authorization decisions, as well as an increase in throughput and a reduction in backlogged authorizations.

End-to-End Digital Mailroom Transformation

How We've Helped!

We have helped many organizations across the industry better use resources within their company by providing automated, scalable solutions. Smart Data Solutions helped an East Coast Blue Plan integrate an end-to-end digital mailroom, including client-specific health document digitization for claims, appeals, EOBs, enrollments, and other correspondences.

Additionally, we integrated a Provider submission portal and a 2-hour pre-authorization approval workflow. SDS was able to automate manual, complex workflow rules using AI and OCR processing and validation, resulting in 20% savings on administrative costs and reduced error rates by 15%.

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CLIENT TESTIMONY

Debbie Ziegler

“SDS performs all of our front-end services. This includes clearinghouse, scanning, imaging, OCR and mailroom. SDS also facilitates and performs ...”
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CLIENT TESTIMONY

Brian Janssen

“Smart Data operates as the EDI clearinghouse, paper claims and enrollment intake, and 834 enrollment hub for our commercial products. The development ...”
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CLIENT TESTIMONY

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 ...”
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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.”
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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.”
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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.”
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