Implementation & Data Integration

Most implementation pain is a data problem.

A platform migration is rarely difficult because of the platform. It is difficult because claims, provider, and jurisdictional data has to arrive in the right shape, at the right time, matched to the right records — and that work is usually underestimated.

The approach

We've been on the other side of this.

Datos' implementation work is led by a former Enlyte employee who deployed SmartAdvisor® for clients and trained their teams on Capstone® rule writing as part of those implementations. That means we know which configuration decisions are cheap to change later and which ones you will live with for years.

We also know where implementations stall: provider records that won't match, jurisdictional data that arrives incomplete, and integration points that were scoped as a file drop when they needed to be a real bi-directional exchange.

ClaimSync EDI is how we handle the exchange itself →

What's included

Four areas of work.

Implementation support

Hands-on help standing SmartAdvisor up — configuration, workflow modelling, and the decisions that are hard to reverse once volume is flowing through the platform.

Data mapping

Mapping claims, provider, adjuster, and jurisdictional data from your existing systems into the shape SmartAdvisor expects, so records match instead of arriving as near-duplicates.

System configuration

Getting the platform aligned with how your program actually operates, rather than accepting defaults that assume a different kind of operation.

Integration with existing claims systems

Connecting SmartAdvisor to the claims or RMIS platform you already run — whether that is a commercial system, a TPA platform, or something built in-house.

Where projects stall

Five data problems, none of which look like data problems.

Each of these presents as something else — a platform limitation, a vendor issue, a training gap. Naming them correctly is most of the work.

  1. 01

    Provider records that will not match

    The same provider arrives as three records because one feed carries an NPI, another carries a tax ID, and a third carries a name and address that were typed by hand. Every near-duplicate becomes a bill that pends for the wrong reason, and the cleanup cost grows with volume.

  2. 02

    Jurisdiction determined too late

    Which state’s rules apply is the decision every fee schedule and reimbursement rule hangs off. If jurisdiction is derived from data that arrives incomplete, the rules are correct and the answers still are not.

  3. 03

    Claim numbers that are not really keys

    Claim identifiers get reformatted, prefixed, or reused between systems. Two systems that disagree about what identifies a claim will disagree about everything downstream, and the disagreement surfaces as mystery mismatches rather than as an error.

  4. 04

    An exchange scoped as a file drop

    A one-way file was easier to agree to during scoping, and then the program needs status back — reprice results, payment detail, adjuster assignment. Retrofitting a return path is more work than building it bi-directional from the start.

  5. 05

    Defaults that assume a different operation

    Platforms ship with configuration that fits a median customer. Accepting it is fast, and it quietly encodes somebody else’s workflow into yours — usually noticed once examiners start working around it.

Decisions that stick

Some choices are cheap to change later. These are not.

The value of having done this before is not knowing more options. It is knowing which handful of decisions you will still be living with in five years, and slowing down on exactly those.

  • How claims are keyed, and which system owns that identifier
  • Whether there is one provider master or several, and what matching rules govern it
  • How and when jurisdiction is determined for a bill
  • Whether the exchange with your claims system is one-way or bi-directional
  • Where documents live, and which system is authoritative when they disagree

FAQ

Questions we get asked

How long does an implementation take?
It is set by data readiness far more than by platform configuration, which is why an honest answer needs a look at the data first. The things that move the timeline are how clean your provider records are, whether jurisdiction can be derived reliably, and whether the exchange with your claims system already exists in some form.
We are mid-implementation and stalled. Is that too late to bring you in?
No, and it is a normal reason to call. A stalled implementation is usually stuck on one of the data problems above rather than on the platform, and identifying which one is a bounded piece of work.
Do you replace the implementation team we already have?
Usually not. We are typically brought in for the data and integration half — mapping, matching, and the exchange with the systems you already run — which is the half most often underestimated.
Does this require changing our claims system?
No. The point of the integration work is to connect what you already run, whether that is a commercial claims platform, a TPA system, or something built in-house.
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 who deployed SmartAdvisor for clients, which is where the implementation experience comes from.

Planning an implementation, or recovering one?

Both are normal. Tell us where the project actually is and we'll tell you whether we're useful.

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