Improve Payment Accuracy and Reduce Provider Abrasion
Sandata offers an 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. This enables states to avoid payment of unauthorized or unapproved services for claims while minimizing provider abrasion. Sandata solutions give you an effective way to validate EVV claims pre-adjudication, enabling significantly lower claim denial rates and reconciliation costs as well as higher first-pass payments.
Accurate. Efficient. Flexible.
Pre-Adjudication Authorization
Sandata’s solution leverages an enhanced claims matching and editing process to validate homecare claims against EVV data before those claims are adjudicated, significantly reducing the need for subsequent recovery expenses. Say goodbye to “pay and chase.”
Cost Savings
Sandata validates homecare claims against EVV data in a pre-adjudication mode and before claims are received and processed by payers. This contributes to lower claim denial rates and reconciliation costs, as well as higher claim auto adjudication and first-pass rates.
Better Provider Relations
Sandata integrates existing EVV, claim, and payment systems and industry standard EDI formats and allows providers to continue to work with their vendors of choice, thereby significantly reducing provider abrasion.
Out-of-the-Box Solutions for States and MCOs
Sandata has extensive claims validation experience and works with each provider to develop a claims matching process that works best for stakeholders and to ensure providers have access to claims matching results and reporting. The claims matching process supports CMS Certification and KPI reporting requirements.
