Redefining Homecare Excellence: Sandata Leads with Innovative Pre-Adjudication Claims Management Solution

Elevating industry standards, Sandata’s pioneering solution enhances payment accuracy and fraud protection while optimizing processes in homecare services.

In a transformative move to fortify the integrity and efficiency of homecare services and claims payment, Sandata Technologies proudly unveils a powerful pre-adjudication claims editing solution that streamlines and automates the intricate process of managing homecare claims. Sandata’s strategic innovation is set to ensure payment accuracy, reduce provider friction, and elevate overall efficiency in the homecare ecosystem.

A Revolutionary Approach to Claims Management

Sandata harnesses enhanced claims editing capabilities and a partnership with the nation’s leading clearinghouse to seamlessly integrate, inspect, and validate care plans, authorizations, visit details, and claims. This proactive approach to leveraging Electronic Visit Verification (EVV) data ensures impeccable accuracy and significantly diminishes the need for post-payment reconciliation by addressing potential issues before claims are processed and paid.

An Added Layer of Protection and Efficiency

This new solution acts as an additional safeguard against fraud, waste, and abuse by shielding against the risks associated with processing payments without requisite EVV data. It seamlessly integrates with Managed Care Organizations’ (MCOs) existing claims payment systems, eliminating the need for substantial infrastructure investment. Unlike other industry solutions, Sandata’s claims solution is built around industry-standard EDI formats (837, 277, 835), ensuring straightforward adoption and minimal operational burdens for both MCOs and providers.

“With this release, Sandata reaffirms our commitment to reshaping the future of homecare by strengthening connections between payers and providers,” asserts Emmet O’Gara, CEO of Sandata. “This represents a paradigm shift in the way the industry responds to the challenges faced by MCOs and homecare agencies. It reduces errors and ensures swift, accurate payments, which lead to smoother operations and heightened satisfaction. Plus, it aligns with Sandata’s mission to transform the Medicaid homecare system to work better for everyone.”

Value Proposition to MCOs and Providers

By validating homecare claims against EVV data before reaching MCOs, Sandata simplifies adherence to EVV compliance without necessitating modifications to existing adjudication systems. This is poised to decrease claim denial rates and lower reconciliation costs while bolstering auto-adjudication and first-pass rates, thereby ensuring more timely processing of claims.

“Our solution suite empowers MCOs with the capability to evaluate their provider network performance, and gain detailed insights into every claim, member, and caregiver, within the ecosystem,” highlights Doug Fleishman, Chief Revenue Officer at Sandata. “Importantly, all these enhancements are achieved without requiring providers to overhaul their existing billing systems, minimizing friction and fostering widespread adoption.”

About Sandata

Sandata Technologies is the pioneering force in the homecare industry, consistently leading the way with innovative technology solutions. As a trusted leader, Sandata is deeply committed to addressing critical challenges in the sector by expertly connecting the homecare ecosystem. This commitment creates a positive and lasting impact on payers, providers, caregivers, and those who receive care. Sandata’s industry-leading software, systems, and services optimize billing and claims processing for payers, streamline administrative processes for providers, and facilitate better experiences for caregivers and those who receive care. Sandata’s vision and commitment to transforming the industry continue to shape the future of care at home and in our communities, ensuring better outcomes for all involved.