Sandata Launches Claims Gateway, Fulfills CMS Requirements for Ensuring Supporting EVV Data Exists for Claims

Woman on computer

Sandata is pleased to announce Claims Gateway, a market-leading invoice submission product for payers. Claims Gateway fulfills Centers for Medicare & Medicaid Services (CMS) requirements for proactively ensuring that supporting Electronic Visit Verification (EVV) data exists for claims. With an efficient and easy-to-use interface, Claims Gateway creates a seamless exchange of information between providers and payers as well as promoting high participation rates. 

“Our provider communities are facing a host of challenges running their agencies,” said Emmet O’Gara, Sandata CEO. “This tool helps them act quickly in submitting and correcting claims but in doing so, it also creates a timelier and more reliable source of information for the payers. We’re glad to have a tool to help facilitate this important function between the two.”  

 

Claims Gateway  Competing Products 
Providers upload files from their system and have a real-time view into pass/fail status  Providers wait for a rejection and in some cases have to submit duplicate entries in their system and the claims verification solution. 
Claims that are approved get passed along for payment while providers address those that failed and re-submit.  If one claim is denied the entire batch may fail and the provider may have to wait for any payments until all claims in the batch are approved. 
Clear coding on rejected claims to make it easy to fix the error(s) and resubmit.  Delayed information on rejected claims, which can lead to delayed payments and provider cash flow issues. 
Minimal or eliminated double entry for providers, allowing for a single source of truth.  Providers work in their current agency management system AND separately in a claims validation solution, increasing risk for incorrect information and reconciliation headaches. 
Payers achieve reduced friction with providers and know they are paying against clean claims.  Payers have increased administrative time helping providers through validation and divert resources to double verify claims being paid. 

 

Now providers can upload their bill files through the new Claims Gateway module for claim validation. The submitted files are validated and the provider receives quick pass/fail responses while the claims are being reviewed. Not only will the provider be assured in cases where the claim is verified and ready for payment, they will also be advised on claim rejections and be able to immediately address any errors. The instant validation offered eliminates delays and ambiguities for the provider. 

Importantly, providers can use their current agency management solution and still benefit from Claims Gateway. Providers do not have to add on more tools to get through the process as they do with competing products. 

Payers experience improvement in meeting CMS key performance indicators around EVV record to claim/encounter. 

“We are proud to offer a solution that not only ensures 100% of submitted claims are EVV validated, but also requires no development work by payers or providers,” added O’Gara. “Payers will be excited to learn that they’re receiving only clean claims, which will help them streamline and expedite their payments and creates a more efficient system for all.”  

For payers who are interested in being Cures compliant with the most efficient and provider-friendly system on the market, the Sandata team is available to answer questions and provide a demonstration.  

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