SMART DATA SOLUTIONS

We provide full mailroom capabilities and we offer the option for opening mailroom facilities in any locations per customer request. Mailroom services include the following:

Mail Receipt
Mail Sort (currently our most complex client has over 170 claim sorts)
Automated Data Base Sorts
Document Preparation
Scanning (SDS ScanRite Scanner Control Software)
Automated Document Control Number (DCN) Assignment
Imprinting
Bates Stamping
Integrated Quality Control
Backlit X-Ray Scanning
Reject Processing
Reject Categorization and Associated Work Queues
Routing of Misdirected "White-Mail"
Eligibility and Claim Form Return
Automated Cover Letter Generation Noting All Reject Reasons
Automated Sort and Aggregation by Mailing Address
HIPAA Compliant Document Destruction

In addition, our system is complemented our Mailroom Accountability and Control System (MACS) our internally developed mailroom control system. MACS ensures the efficient and timely delivery of mailroom services.

Our mailroom can also process "white-mail" (other documents received at the PO Box, such as doctors notes, collateral and correspondence). White-mail can be sorted by Smart Data staff prior to return or scan. Clients often categorize how they would like white-mail sorted and scanned. In addition, clients typically set-up work queues so client personnel can enter the system and process the white-mail accordingly. Mailroom employees do not leave for the day until production is complete.

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Does SDS scanning include automated document control number (DCN) assignment?

Yes, SDS scanning includes automated Document Control Number (DCN) assignment, however, this is customizable. Typically we imbed the Julian date into the DCN. Regardless, our ScanRite scanning software tracks the scan and receive date of the document. This information is then indexed to the document.

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What is SDS’s data capture and data entry workflow?

SDS's data capture and data entry workflows provide a highly accurate and customizable to meet any client needs. Below is further information about the SDS QuickClaim data capture subsystems including security components:

Capture Systems

SDS utilizes a variety of capture and quality control subsystems to ensure rapid and accurate return of claim data. Below is a brief overview of these systems:

Optical Character Recognition (OCR): SDS utilizes OCR to improve quality, reduce cost and shorten turnaround time. NOTE: SDS can now perform OCR on Black & White as well as "red drop" forms.

Key From Image (KFI): Claims that cannot be processed by OCR are routed to our internally developed KFI system. Our KFI system also includes low level validation edits.

Quality Control Module: Captured claim data is subject to quality control edits. For example, captured names are compared with a US Census Bureau listing of names. If the captured name does not match our Census Bureau database it is automatically subject to a second review.

Double Key Module: SDS utilizes "OCR Enhanced" double key. This provides highly accurate data using less labor thus reducing client costs. The double key module can be used on selected fields or the entire claim.

Audit: SDS utilizes an ISO compliant audit system. The system is unique in that it incorporates real time corrective audits. This approach yields two benefits. First, any errors identified in the audit are corrected prior to export thus improving client data. Second, the keyers are provided error feedback within four hours of keying. This rapid feedback allows us to identify and correct keying errors rapidly.

Capture Workflow Applications: Rejected claims and claims requiring modification are an unavoidable consequence of the data entry function. Reject processing is extremely time consuming and can introduce processing delays.

RejeXpro Rejects Processing Queue: RejeXpro enables the review and modification of transactions that would have otherwise been rejected. (The criteria for routing to the queue are set on a per client basis.) Once in the queue, claim or eligibility transactions can be modified to enable accurate submission. For example, the rendering physician name may be illegible on the claim form. Using RejeXpro, we can avoid a reject by identifying the physician name, populating the transaction and resubmitting.

WebKey (Key to 837): This web-based application enables the data entry of claims with subsequent real time conversion to an 837 transaction. WebKey supports Institutional, Professional and Dental transactions. The system presents keyers with a template that mimics the UB, HCFA or Dental form. Once entered, the transaction is automatically validated with any violations presented to the keyers.

Modiff-I Transaction Modification Queue: Clients sometimes need to modify transactions prior to submission to their adjudication system. For example, claims subject to clinical editing may be materially modified including the addition and removal of billing lines. With Modiff-I, the client can revise the transaction and resubmit to the PPO for repricing. (This queue can be used for paper or EDI sourced transactions.)

Eligibility Review Queue: This system enables the client to specify conditions in which eligibility matches are reviewed. Typically, the SDS MemberMatch application enables fully automated eligibility matching. However, there may be situations such as incomplete eligibility data in which the client specifies manual review. This queue enables that review.

SDS data capture systems are highly secure. Specifically, claim data and claim image files do not leave our Minnesota facilities. (We utilize "thin client" technology.) Also, our keying facilities include secure access, employee background checks and PC hardware with no removable storage devices. Finally, we utilize both IP address restrictions and multi-tiered passwords to control system access.

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What form types does SDS provide a claim workflow for?

SDS provides support for the following transactions in our claim workflow:

837P: Healthcare Claim Professional
837I: Healthcare Claim Institutional
837D: Healthcare Claim Dental
835: Healthcare Claim Payment Advice
270/271: Healthcare Eligibility Coverage or Benefit Inquiry
276: Healthcare Claim Status Request
277: Healthcare Claim Status Response
277/275: Healthcare Claim Request for Additional Information
834: Payroll Deducted and Other Group Premium Payment
Faxes
Electronic Attachments
Direct Data Entry (DDE)
Eligibility and Enrollment Forms
Spousal Coverage Verification Forms
Doctor's Notes
Non-Standard Forms
Proprietary Forms
Practice Management System
PPO Routing and Direct Connections
EOB Forms
5010 Transactions

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What clearinghouse and EDI products and services does Smart Data Stream offer?

Smart Data Stream's clearinghouse and EDI services include:

Provider Outreach
Paper Submission Elimination
Electronic Claims Processing (Professional and Institutional)
Electronic Attachment Submission
Referrals and Authorizations
Electronic Remittance Advice (ERA)
835 EFT Processing
Workers Comp and eBills
Medicare Med-Sup Cross Connect
Claim Status
Data Conversion
Data Editing
Claim Editing
Provider File Matching (SmartMatch)
Member Matching (MemberMatch)
Duplicate Checking
Image Archive and Retrieval
Claims Consolidation
EDI Routing and Translation
EDI Conversion and Management
Hierarchical PPO Routing
Direct Connections
One-Stream EDI Gateway
Cost Containment Connectivity
Check and EOB Connectivity
CMS Mandatory Insurer Reporting
Back-End Processing

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Does SDS perform 5010 conversions on claims? ICD-10?

SDS supports all ANSI X.12 5010 transactions. We have our own internally developed translator thus allowing for greater flexibility. Our transaction validation engine is fully configurable.

SDS is able to handle ICD-9 versions and the new ICD-10 as they become available. We are currently working with several of our clients with this transition.

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Does SDS perform fax processing?

SDS has a workflow based fax processing system. Specifically, our system eliminates the need to print and scan fax receipts. We will automatically sweep your fax servers to retrieve the documents, group the pages, identify the document, data capture, edit the data, and route to the appropriate queue in correct format. We can provide reject queue notifications, and correction interfaces for your faxed documents. This, in-turn, reduces your costs and your TAT.

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Does SDS provide services for electronic attachment submission?

Smart Data currently codes attachments for other customers. Our system also allows for attachments to be subsequently hitched to the primary document. All coding will be attached to the main document.

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Does SDS provide services for Medicare Med-Sup Cross Connect?

Payers of Medicare Supplemental Insurance often receive both paper and electronic versions of EOBs, which can result in overpayments, lost time and lost money. SDS prevents these expensive duplicates by automatically comparing the ICN of any EOB entering the system through the following process:

SDS takes the electronic 837 off the provider's claim management system and captures the data while document the ICN
If any additional paper or electronic claims are received SDS compares the ICN with previously received ICNs
If any duplicates are found the duplicate is deleted and reported back to the client

The benefits of Smart Data’s Med-Sup Cross Connect solution include:

Lower processing cost
Immediate duplicate checking
Elimination of duplicate payments

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Does SDS perform PPO Routing?

SDS performs PPO Routing supported by our claim archiving and reporting engines. Clients have the ability to track claims at all times including routing history. In addition, SDS PPO Routing provides direct connections to many PPOs.

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Does SDS perform Mandatory Insurer Reporting (MIR)?

Smart Data Solutions does provide Mandatory Insurer Reporting (MIR) support. Smart Data can assist a client with group health plans in the following ways:

Ability to manage your initial and quarterly eligibility submissions to COBC
Reformat your file of insured's so it is accepted by COBC
Provide a web interface to change the insured information where needed
Handle and process rejects to COBC with SP disposition coded by providing you an interface for corrections
Track and crosswalk all DCN, adjudication numbers, and HICN numbers
Provide real-time reporting and alerting to always keep you updated
Manage active covered individuals and the TINS they are affiliated with
Send the proprietary file to COBC
Manage the social security number gathering that is required
Manage the MSP number returned from CMS with '01' disposition code
Handle new data field needs
Manage communication and alerts from COBC

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Does SDS provide portals for multiple user groups?

SDS provides member, employee, and provider portals in which users are able to view benefit info, co-pay coverage, SPPs, Request ID cards, view announcements and other related data services. SDS portals provider lower costs, less administration, high member satisfaction and custom branding.

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Does SDS provide enrollment solutions?

SDS provides enrollment solution. Everyone's enrollment form is unique. We develop unique data entry documentation in conjunction the implementation because each client's enrollment form is unique. This documentation is reviewed with the client. Also, the documentation can be made available real time as part of our custom keying application. In addition, SDS also does DDE of enrollment applications.

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Does SDS perform claim payment, EOB processing and/or EOMB processing?

Yes, SDS performs processing of claim payments, EOBs and/or EOMBs claims. Our system provides HIPAA compliance, security, and more efficiency in claim payment, and EOB and EOMB processing.

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What is MemberMatch and how does it help with eligibility criteria analysis?

MemberMatch enables fully automated, sophisticated eligibility matching that ensures an accurate match. Our process includes sophisticated member matching logic to ensure an accurate match. Then, once the match is made the associated "backfill" and routing are executed prior to export.

We use robust testing methodology to ensure the eligibility matching accuracy of our automated processes exceeds that of existing manual processes. Our system provides consistent, accurate matches, which, in-turn, improve payment accuracy and reduce labor costs.

Our system enables the client to specify conditions in which eligibility matches are reviewed.

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Does SDS perform Provider File Matching and have a PFM system?

Our provider file matching is a complex system that uses a weighted combination of string comparison algorithms, a modular design and "process of elimination" approach to tease out the corresponding provider in your database. Our current match rate statistics for clients utilizing provider file matching is 100%. This is achieved through regular provider file updates and proper claims data.

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What are Smart Data Solutions and Smart Data Stream’s quality control measures?

Smart Data Solutions and Smart Data Stream perform the following quality control measures:

Quality Control Module: Captured claim data is subject to quality control edits. For example, captured names are compared with a US Census Bureau listing of names. If the captured name does not match our census bureau database it is automatically subject to a second review.

Billing Line Quality Control: In this phase we compare the total charge with the sum of the line charges. In the event they do not agree, the claim is sent to the Billing Line Quality Control Module. This module allows for addition, removal and modification of billing lines.

General Quality Control Edits: Quality control edits fall into the following three categories:

Data Integrity Edits: Used to "tease out" data entry errors. For example, if the billing "from date" is after the "to date" the claim is subject to a second review.
Transformation Edits: This includes items such as name parsing and conversion from minutes to units for anesthesiology claims.
EDI Compliance Edits: This includes enforcement of EDI rules. For example, on a UB an occurrence code must be accompanied by an occurrence date.

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Does SDS provide real-time reporting?

SDS real-time reports include:

Mail Received per Mailboxes
Mailroom Counts
Active Claim Mailing Locations
OCR/KFI Report
Incoming Batches
Expected Batch Receipt Status
Expected Export Delivery Status
Claim In Process Report
Claim In Out Report
Completed Claim Report
Inventory Aging Report
Submitted File Report
Submitter File Control
Form Balancing
Image Identification Queue
Attachment Identification Queue
Direct Data Entry Queue
Key Direct Queue
Uploaded Provider File Search
Provider File Search
Contracted Provider Queue
Non-Standard Data Entry
Superbills Data Entry
Prescription Data Entry
Dental Non-Standard Data Entry
Vision Data Entry
EOB Mismatch Data Entry
EOB Keying
EOB Reconciliation
Claims Review Portal
View Open Batches
Batch Report Email
Batch Summary Drill Down
Document Summary
Document Notes
Document Details
Document History
Hitching Documents
Hitching Queue Report
HCFA Editor
Failed Exports
EDI Validation Failed Summary
EDI Validation Errors Report
Reject Claims Queue
Pended Reject Queue
Reject Letter Queue
Documents Awaiting Re-export
Reject Stats Report
Error Trend Report
Audit Field Accuracy
Audit Summary Report
Certification Report
DEP Audit
QC Stats Report
QC Ratio Report
QC Audit Report
Production Report
EDI Routing Report
PPO Routing Table
PPO Group Crosswalk
PPO Routing Summary
PPO File Submitted Report
PPO Routing Statistics
Trading Partner Receipt Report
Turn-Around Time Batch Report
User Access History
User Activity Report
HIPAA Tracker
Email Distribution Lists
Password Management
Web Benefits and Enrollment Maintenance
Enrollment Document Search
Enrollment Document View
Enrollment Commercial Annotation
Enrollment Government Program Annotation
Enrollment Miscellaneous Annotation
Enrollment New Group
Enrollment Pool
Enrollment Reject Queue
Manual Eligibility
Eligibility Matching
Eligibility Match Statistics
Eligibility Aged Summary
Pended Eligibility Review
Indexing Queue
Document Indexing
Auto Close Indexing Queue
Medicare ICN
Repricing Sheet
Repricing Automated Alerts
Repricing Results Report
Billing Report

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Does Smart Data Solutions and Smart Data Stream have a claims queue in order to view and archive claims?

SafeClaim is our web based imaging and retrieval system. With SafeClaim, images are available for retrieval within fifteen minutes of scanning the batch. After the capture phase, the claims can be retrieved based on any data captured off the claim. (Retrieval screens are typically customized for each client.) Images are available for 10 years and are available via web browser or API. SafeClaim includes the following features:

24/7 Access
Ten Year Claim Access
Indefinite Image Storage for Contracts/etc
HTTPS Secure Web Access
No Limit on Number of Users
Notes (Ability to annotate claims)
Hitching (Allows subsequent related documents to be "attached" to a claim)
Ability to print or e-mail from system
Back-up in triplicate
HIPAA tracker capability (Reports on everyone who has viewed the document)

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What is SafeClaim?

SafeClaim is our online claim image and storage system in which we upload claims for simple searching later. In addition you can view tracking, statistics, enrollment and other workflow reports.

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What disaster recovery and business continuity systems are in place?

SDS has a full disaster recovery and business continuity plan in place to effectively react to loss of electrical, loss of network, los of physical computing facility, loss of employee, and loss of keying facility. The goal of SDS is to restore business continuity within 48 hours of an outage or disaster. SDS maintains a parallel computing infrastructure. Each facility is capable of supporting SDS production. SDS contingency business partners already work some SDS jobs and have high production potential. SDS tests this plan annually.

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How do Smart Data Solutions and Smart Data Stream stay current with federal regulations?

We continually monitor the regulatory environment to understand the full scope of our compliance responsibilities. When changes are made, we respond well in advance, and test all changes to make sure we remain in compliance.

Smart Data adheres to all HIPAA mandates. All employees are trained on the privacy and security aspects involved with HIPAA and Smart Data has taken precautions to make sure we are HIPAA compliant. Our data centers are highly secure, and our scanning centers have multiple security points prior to access. Our log in requires double user name password along with IP address restrictions.

We are very serious about maintaining compliance with HIPAA security requirements. Specifically, we are SAS 70 type two certified and recently completed an extensive security and penetration audit conducted by BCBSMN. In addition, we are an active member of both the EDI standards board and WEDI, for which we attend conferences and participate in educational forums to discuss policy updates. Our entire process is secure and adheres to all HIPAA mandates in each of our services — from the initial image upload, through the data-capture, data-scrubbing, archiving and all the way to the file return and EDI routing. All employees are trained on the privacy and security aspects involved with HIPAA.

In addition, we regularly perform a wide array of internal audits as part of our ISO compliant internal QC systems. Random samples are programmatically adjustable on a per client and form basis. Typically we audit between four and five percent of the claims, and we audit 100% of the fields on the claims we audit. Keyers receive audit feedback within one to four hours. This report provides "month-to-date" totals as well as allowing for "drill downs" to view specific errors. Any errors identified are corrected pervious to batches being returned to the client.

We use the above to assess risk after which we prioritize remediation. Many security initiatives are identified internally. For example, we recently implemented password encryption within our database.

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