Blues Organizations

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.

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.

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.

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.