Sold by: UST
UST SmartOps automates end-to-end claims adjudication for Drug Discount Plans by extracting data from claim documents (UB04, CMS1500, EOBs), validating against enrollment and benefit data, and applying rules-driven workflows to accelerate processing. Proven results: 70% effort savings, 96% faster turnaround (5 days to 4 hours), and 100% claims traceability.
Overview
UST SmartOps automates end-to-end claims adjudication for Drug Discount Plans, replacing manual document processing with intelligent, rules-driven workflows.
THE CHALLENGE Organizations managing Drug Discount Plans face significant operational inefficiencies due to manual claims processing. Adjudicators must extract key information from complex documents--including UB04, CMS1500, Explanation of Benefits (EOBs), member enrollment data, accumulator data, and benefit summaries--then manually validate it against multiple data sources. This labor-intensive process is time-consuming, error-prone, and results in lengthy turnaround times.
THE SOLUTION UST SmartOps delivers a modular, automated approach to claims adjudication:
• SmartVision: Automatically extracts critical data from claim documents such as UB04, CMS1500, EOBs, and supplementary data sources, eliminating manual data entry.
• Automation Story: Designs and implements automated workflows across the entire claims processing lifecycle. Upon receiving new claim files, the solution automatically triggers data extraction, validation, and adjudication processes.
• Rule Engine: Applies pre-defined business rules to validate extracted information against member enrollment records, accumulators, and drug coverage criteria.
• Seamless Integration: Orchestrates data flow between SmartVision, Automation Story, and existing client systems for efficient end-to-end processing and data management.
PROVEN RESULTS In a real-world deployment, UST SmartOps delivered measurable impact:
• 70% effort savings across claims processing operations • 96% improvement in turnaround time--reducing processing from 5 days to just 4 hours • 100% traceability of claims processing, ensuring full audit compliance and transparency
UST SmartOps empowers healthcare and benefits organizations to dramatically accelerate claim resolution, reduce operational costs, and maintain complete visibility into every step of the adjudication process.
Highlights
- Automated document extraction via SmartVision processes UB04, CMS1500, EOBs, member enrollment, accumulator data, and benefit summaries--eliminating manual data entry
- Rule engine applies pre-defined business rules to validate claims against member enrollment, accumulators, and drug coverage criteria for accurate adjudication
- Proven results: 70% effort savings, 96% improvement in turnaround time (from 5 days to 4 hours), and 100% traceability across the claims processing lifecycle
Details
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Support Scope
Our support services include:
- Product onboarding and configuration guidance
- Integration assistance for connecting the solution with enterprise applications, third-party platforms, and business systems
- Troubleshooting and resolution support for product features, workflows, automations, and integrations
- Account, subscription, and billing support, including refund-related requests where applicable
- Deployment and implementation consultation based on organizational requirements and technical environments
Typical Engagement Structure
- Discovery and Planning
- Assessment of business and technical requirements
- Environment evaluation
- Integration and deployment planning
- Solution architecture documentation
- Pilot Implementation
- Product configuration and setup
- Workflow validation and testing
- User feedback collection
- Iterative optimization and tuning
- Production Deployment
- Full-scale rollout and go-live support
- Performance monitoring
- Ongoing optimization and operational support
Customer Responsibilities
To ensure a successful implementation, customers should:
- Designate a primary technical point of contact to support integration and deployment activities
- Provide access to relevant systems, environments, and documentation as required
- Validate solution behavior, business rules, and workflows within their operational environment
Getting Started
To request a product demonstration, discuss implementation options, or obtain additional information, please visit the product contact page
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