Health Plans

With recent changes in the industry including frequent mergers and acquisitions, digital transformation and workflow optimization have become a major focus. As an expert in healthcare process automation, Smart Data Solutions can be a strategic partner for you, helping you manage your data in a more efficient and effective way. This allows you to focus on other important areas of your operation, including cost management, quality of care, stability, and business growth.

Smart Data Solutions has helped our Health Plan customers reduce costs by an average of 24%.

Health Plans

Consolidated Vendor Support

Partnering with Smart Data Solutions gives you the capability to consolidate your vendors in a way that supports all lines of business, whether it be commercial, government, federal, Medicare, Medicaid, or something else. With over 20 years of experience, we recognize the nuances of each industry and are equipped to provide solutions that cater to your unique business needs.

Through our OneStream Managed Gateway, you can manage and view all relevant data, both paper and electronic. Our solutions also help to manage EOBs/EOPs, Medicare crossover, and consolidated remittances all in one convenient place. Additionally, this platform simplifies paper and EDI transaction processing for healthcare Payers, creating a centralized stream of inbound transactions to improve auto-adjudication rates with full transparency and reconciliation.

Health Plans

Automating Workflow Processes

Manual workflows are more expensive and time-consuming than their automated counterparts. Electronic transactions help to alleviate the headache of using paper by providing faster turnaround times, easier communication between Payers and Providers, and significantly scaling down administrative work. Smart Data Solutions not only helps to handle pre-existing EDI transactions but can also help your organization convert any paper document into structured and standardized formats, effectively streamlining your workflows by cutting costs on any paper in your process. 

Smart Data Solutions can automate your mailroom and data capture processes using proprietary technology, providing the highest level of automation in the industry. We have the capability to pull any data from healthcare documents while accounting for business rules and other caveats using Deep Learning and Statistical Machine Learning models, as well as 4 different OCR engines, and over 1,000 proprietary edits.

Health Plans

Risk Management

Outsourcing and consolidating vendors result in enhanced stability and security, which allows for better compliance. Smart Data Solutions is both HITRUST and SOC 2 certified, and we conduct annual audits internally to ensure the utmost security for all our clients. Additionally, SDS conducts annual risk assessments and has an entire security team dedicated to ensuring all sensitive information is protected.

Health Plans

Consolidated Vendor Support

Partnering with Smart Data Solutions gives you the capability to consolidate your vendors in a way that supports all lines of business, whether it be commercial, government, federal, Medicare, Medicaid, or something else. With over 20 years of experience, we recognize the nuances of each industry and are equipped to provide solutions that cater to your unique business needs.

Through our OneStream Managed Gateway, you can manage and view all relevant data, both paper and electronic. Our solutions also help to manage EOBs/EOPs, Medicare crossover, and consolidated remittances all in one convenient place. Additionally, this platform simplifies paper and EDI transaction processing for healthcare Payers, creating a centralized stream of inbound transactions to improve auto-adjudication rates with full transparency and reconciliation.

Health Plans

Automating Workflow Processes

Manual workflows are more expensive and time-consuming than their automated counterparts. Electronic transactions help to alleviate the headache of using paper by providing faster turnaround times, easier communication between Payers and Providers, and significantly scaling down administrative work. Smart Data Solutions not only helps to handle pre-existing EDI transactions but can also help your organization convert any paper document into structured and standardized formats, effectively streamlining your workflows by cutting costs on any paper in your process. 

Smart Data Solutions can automate your mailroom and data capture processes using proprietary technology, providing the highest level of automation in the industry. We have the capability to pull any data from healthcare documents while accounting for business rules and other caveats using Deep Learning and Statistical Machine Learning models, as well as 4 different OCR engines, and over 1,000 proprietary edits.

Health Plans

Risk Management

Outsourcing and consolidating vendors result in enhanced stability and security, which allows for better compliance. Smart Data Solutions is both HITRUST and SOC 2 certified, and we conduct annual audits internally to ensure the utmost security for all our clients. Additionally, SDS conducts annual risk assessments and has an entire security team dedicated to ensuring all sensitive information is protected.

Revolutionize Your Processes with a Digital Transformation

Digital transformation in healthcare is extremely relevant as technology continues to advance and workflows become more complex. Streamlining taxing paper and manual processes for all types of healthcare documents can revolutionize your operations and directly impact your ROI. With the use of Smart Data Solutions’ efficient and time-saving technologies, your organization can focus on member engagement and operational growth. We offer tools that are relevant to both Medicare Advantage and Medicaid health plans to help you optimize your workflow, including scalable AI technologies. Our all-encompassing platform includes over 170 Machine Learning models and other proprietary technologies unique to SDS.

A digital transformation can directly affect your customers. Documents can be processed more efficiently, closing the loop faster, and improving customer experience, as processing bumps can be avoided or eliminated entirely. Streamlining workflows in any way possible with current technologies sets you up for success both now and in the future. 

Get Started  
9 TONS
of mail per week
500M
Transactions Annually
85
Net Promoter Score
500+
Clients
icon

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 ...”
View Story
icon

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 ...”
View Story
icon

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 ...”
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

Recent Articles

View All 

Healthcare Automation Leader Smart Data Solutions Has Been ...

EAGAN, Minn., Feb. 1, 2023  -- Smart Data Solutions (SDS), a technology leader in healthcare process automation for front, ...
Read Article

Healthcare EDI Trends in 2023 and Beyond

Electronic Data Interchange (EDI) has become an increasingly important technology in the healthcare industry, especially in ...
Read Article

Prioritize Patients with High-Touch Healthcare Claims ...

What do today's patients care about? The National Library of Medicine concluded patients evaluate their healthcare experiences ...
Read Article

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.

Start Customizing Your Solution