Claims Validation

Sandata Claims Validation: Improve Payment Accuracy and Reduce Provider Abrasion

Sandata has long championed the open Electronic Visit Verification (EVV) model, where providers can choose to use their own EVV system or use the state-supplied EVV system. Sandata also championed the Open Billing model, where providers can continue to use their current claims process while still confirming EVV data to validate the claims prior to payment. These two models set Sandata apart from the competition, enabling states to avoid payment of unauthorized or unapproved services for claims while minimizing provider abrasion.

Accurate. Efficient. Flexible.

Greater Claim Matching Accuracy

The most important requirement for Claims Validation, meaning confirming there is EVV data for a paid claim, is to determine the specific “rules” to match EVV visit and claims data. Sandata has successfully led 58 payers in seven states through this claims validation process and knows from experience the questions to ask and potential problem areas to avoid.

Multi-Payer Support

Claims will be checked only against the data for the programs and payers specified in each claim – so all payers and programs can use the same interface.

100% Verified Visits

Sandata collects EVV data from all sources and evaluates them against the state’s program rules, every time, ensuring all visits meet the 21st Century Cures Act and state requirements.

Clear Responses

Standard adjudication responses make interpreting the results easy and fast.

Flexible Interface

Works on your claims payment schedule with your tools and your rules. Can be used as a real-time web interface, a batch process, within existing adjudication, or standalone.

Extensive Experience

Sandata has extensive claims validation experience and works with each provider to ensure: a claims matching process and timing that works best for your stakeholders and EVV program, providers have access to claims matching results and reporting, the claims matching process supports CMS Certification and KPI reporting requirements, and program requirements are met by sharing our experience in communicating claims matching results to the provider community.

What Our Customers Are Saying

“We work in multiple states. Sandata’s open model EVV system allows the state to gain the verification data it wants, and we are able to choose the EVV solution that best meets their needs. For us, that is Sandata every time.”

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