Data Capture

Data Capture Overview

Smart Data Solutions provides fully customizable and automated scanning and data capture processes that leads to faster turn-around times, higher accuracy of claim data, and reduced costs.  Smart Data Solutions utilizes a variety of capture and quality control subsystems to ensure rapid and accurate return of claim data.

Conversion Process

Smart Data’s paper to EDI conversion process is a combination of OCR automation and manual data entry subsystems. SDS has built OCR automation for all standard claim types, and we also can help you process your non-claim documents like appeals by indexing and wrapping workflow around the doc. The focus is on accurate and rapid return of claim data. Below is a brief overview of the subsystems:

Optical Character Recognition (OCR): SDS’ OCR tool is proprietary which gives us the flexibility to customize and enhance it to deliver a continuously high quality and cost-effective solution.

Key From Image (KFI): Claims that cannot be processed by OCR are routed to our internally developed KFI system.

Quality Control Module: Captured claim data is subject to quality control edits. For example, captured addresses are compared against a national postal database. If no match is found, it is automatically subject to a second review.

Base Double Key Module: Smart Data Solutions 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.

Enhanced Double Key Module: We use this for super critical fields. This process is triggered in the event the referee keyer does not agree with either of the two previous keyers. In this situation the field is again keyed by a senior keyer. This approach further increases accuracy.

Indexing Non-Claim Docs & Workflow Queues

There are numerous challenges when processing non-claim correspondence:

  • High cost
  • Large volume swings
  • Error prone
  • Market specific turn-around times
  • Limited tracking
  • Labor intensive
  • Handwritten

Smart Data’s comprehensive paper to EDI conversion solution helps ensure your staff are able to easily process non-claim documents such as appeals, member reimbursements, operative notes, adjustments, Rx claims, etc.

Once SDS indexes the document, we route it to a queue where your users will have the ability to see the indexed fields and begin processing the document. Within the workflow queue your users will have the ability to take actions on the documents such as approve it, set to in progress, set to complete, send for re-indexing, forward to another queue, make notes, and more.

Quality Control

Providing quality claims data to our clients so they can auto-adjudicate claims is of utmost importance. Our QC consists of:

  • Field format validation (automated and customizable on per field basis)
  • Higher level business logic (dates within expected range, accident claims have a date, city/state/zip combo correct?)
  • Custom business rules
  • CPT validation
  • Balancing (ensure line items billed add up to the total amount billed)

Additionally, we screen all claims against a list of edits that searches for reject conditions. We can customize this on a per field basis which gives our client implementations control and transparency, while ensuring the highest quality possible.

Audit

Smart Data Solutions 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 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.

Reports

SDS offers numerous real-time reports for our clients to access. Please contact us for a full overview of the reports available.

Capture Security

Smart Data Solutions data capture systems are highly secure. Specifically, claim data and claim image files do not leave our Minnesota facilities. 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. Smart Data is also currently obtaining HITRUST certification.