Capstone® Rules Engine Consulting
Your savings rate is a configuration problem.
Savings performance in SmartAdvisor® is largely a function of how well the Capstone rules engine is configured. We write and tune those rules — jurisdiction-specific fee schedules, CPT/HCPCS/ICD-10 coding edits, modifier logic, and policy rules — so they apply consistently to every bill.
Why us
Insider expertise, where it counts.
Datos' Capstone work is led by a former Enlyte employee with comprehensive, hands-on SmartAdvisor experience — from implementation and data integration through rule development, workflow modelling, and the Claims Examiner Portal.
The Capstone rules engine is the backbone of SmartAdvisor's automation. It's what makes 50–70% straight-through processing possible, and it's the first place to look when savings rates are being questioned. Where current results are underperforming, we run a complete rules audit to find weak logic, misapplied fee schedules, and missed edit opportunities — then optimize the rule set to recover the savings.
All of it inside the platform you already run. No migration, no rip-and-replace.
What we do
Six ways we work on a Capstone environment.
Custom rule development
New business rules built for your bill review workflows, fee schedules, and automation requirements — written to maximize straight-through processing rather than to pass a checklist.
Rule troubleshooting & optimization
Diagnosis and resolution of existing rule issues: performance problems, logic corrections, and the fine-tuning that turns a rule set that technically runs into one that actually contains cost.
Complete rules audit & documentation
A full review of your Capstone rules library with written documentation — for compliance, regulatory reporting, and knowledge transfer when the people who wrote the rules have moved on.
Implementation & data integration
SmartAdvisor implementation support, data integration guidance, and system configuration so the platform runs cleanly against your existing claims systems.
Training & knowledge transfer
Capstone rule-writing training for your team, so rule changes stop being a vendor ticket and become something your own staff can do.
Ongoing technical support
Continuous help with your SmartAdvisor implementation, Capstone rule maintenance, and the integration points into Claims Examiner Portal and the rest of your bill review stack.
Beyond fee schedules
Best contract, not first contract.
Capstone rules can be configured so contract and network reductions are selected to achieve the best available result on each bill, rather than following a rigid hierarchy. Traditional network stacking applies the first contract found in priority order and stops — leaving money on the table and creating stacking conflicts.
We've implemented the alternative on a program spanning more than 50 contracted PPO networks: evaluate every available contracted rate simultaneously, apply the single deepest reduction. More savings, no stacking conflicts, and one clean, defensible network rate on every EOR.
Who we help
Built for teams already committed to SmartAdvisor.
P&C carriers, TPAs, and managed care organizations using or implementing Enlyte's SmartAdvisor platform who need expert help with Capstone Business Decision Manager, data integration, or team training — specifically those looking to:
- Improve straight-through processing rates beyond the 50–70% industry standard
- Successfully implement SmartAdvisor with proper data integration
- Enhance cost containment and medical bill review accuracy
- Build internal Capstone expertise through comprehensive training
- Troubleshoot complex rule logic, data integration, or performance issues
- Document existing rules for compliance and regulatory reporting
FAQ
Questions we get asked
- What does a rules audit actually produce?
- A written review of your rule library: what each rule is doing, where rules overlap or contradict each other, which ones no longer fire, and where recoverable savings are being missed. The documentation is the deliverable and it is yours to keep, including if you take it to somebody else to implement.
- Why would savings be low if the platform is configured correctly?
- Because the platform is not what decides your savings — the rules are. Straight-through processing in the 50–70% range is the normal state of a configured system, and the gap between that and what is achievable is rule work: jurisdiction-specific fee schedules, coding edits, modifier logic, and policy rules applied consistently to every bill rather than to most of them.
- Can our own team write rules after you leave?
- That is the intended outcome, and training is part of the service. The goal is that a rule change becomes something your staff can do rather than a vendor ticket with a queue in front of it.
- Do we have to change platforms?
- No. This is work inside the platform you already run. Nothing gets migrated and nothing of ours has to be adopted to get the rules improved.
- Are you affiliated with Enlyte?
- No. Datos Software is an independent consulting and technology firm, not affiliated with, endorsed by, or sponsored by Mitchell International or Enlyte Group. Our founder is a former Enlyte employee with hands-on Capstone and SmartAdvisor experience, which is where the expertise comes from — it is not a vendor partnership.
Bring us your rules library.
A rules audit is the usual starting point. It tells you where savings are leaking before anyone commits to a project.