Ongoing Technical Support
A rule set that isn't maintained is a rule set that's decaying.
Configuration is not a one-time project. Fee schedules update, contracts change, coding practices move, and volumes shift. Without someone tending the rules, savings performance erodes quietly — and nothing looks broken while it happens.
What we cover
Continuous, not on-call-only.
Capstone® rule maintenance
Rules need revising when fee schedules update, jurisdictions change requirements, or your program starts handling a new line of business. We keep the library current instead of letting it drift.
Monitoring
Watching the numbers that tell you something has quietly stopped working — pend volumes, straight-through rate, savings by jurisdiction — so a regression gets caught in weeks rather than at year-end.
Integration support
The EDI jobs, file transfers, and API connections that move data between your systems. When a feed breaks at 2am, somebody has to know what it was supposed to do.
Ongoing optimization
Programs change. New contracts, new clients, new volumes. We revisit the configuration as the program evolves rather than treating go-live as the finish line.
Why it matters
We already run business-critical jobs.
Datos runs production integrations and scheduled jobs for bill review operations today. Clients depend on those jobs completing overnight so their examiners have work in the morning. That is the standard we hold support work to.
Support engagements are usually paired with a rules audit at the start, so we're maintaining a configuration we understand rather than inheriting one nobody has documented.
Why this is never finished
Five things that move whether you touch the rules or not.
A rule library is not a document. It is a set of assumptions about fee schedules, code sets, and jurisdictions — and every one of those assumptions has an expiry date somebody else controls.
- 01
Fee schedules move
Jurisdictions revise their workers’ compensation fee schedules on their own timetables, and a rule tuned to last year’s amounts does not announce that it has gone stale. It simply reduces to the wrong number, consistently and quietly.
- 02
Code sets change every year
CPT, HCPCS, and ICD-10 all turn over annually. New codes arrive with no rule covering them, retired codes linger in logic nobody revisits, and edits written against a code that no longer exists stop firing without erroring.
- 03
Jurisdictional requirements shift
A state changes a reporting requirement or a reimbursement rule, and the change lands in a configuration written years earlier by somebody who has since moved on.
- 04
The program itself grows
A new line of business, a new client, a new PPO contract, a jurisdiction you have not handled before. Each one arrives as volume the existing rules were never designed for.
- 05
Knowledge leaves
The person who wrote a rule usually knew exactly why. That reasoning is rarely written down anywhere, so their departure converts a maintained configuration into an inherited one.
What gets watched
Naming the numbers is the difference between a claim and a commitment.
"We monitor it" is not a service. These are the specific figures that tell you a rule has stopped matching, and the reason a regression surfaces in weeks rather than at year-end.
- Straight-through processing rate, tracked over time rather than as a single figure
- Pend volume by reason code — a rising pend reason is usually a rule that stopped matching
- Savings by jurisdiction, so a single state’s regression does not hide inside a healthy total
- Duplicate detection rate, which drifts as provider and claim data quality changes
- EDI and scheduled job completion, including the runs that were skipped rather than failed
The last one matters more than it looks. A job that was skipped and a job that ran and found nothing produce the same silence, and only one of them is fine.
FAQ
Questions we get asked
- Nobody has documented our rules. Is that a problem?
- It is the normal starting point, not a disqualifier. Support engagements are usually paired with a rules audit first, so we are maintaining a configuration we have read and documented rather than one we are guessing at. The audit output is yours to keep either way.
- How would we know our savings performance has already eroded?
- Usually you would not, which is the difficulty. Erosion does not present as an error — it presents as a straight-through rate that drifted down two points a quarter, or a jurisdiction whose savings flattened while the total stayed healthy. That is why the numbers above get watched on a cadence instead of being checked when somebody thinks to look.
- Do we have to change platforms for you to help?
- No. All of this work happens inside the bill review platform you already run. There is no migration, and no requirement to adopt anything of ours to get the rules maintained.
- 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. What we do have is a founder who worked at Enlyte and has hands-on experience with SmartAdvisor® and the Capstone rules engine from the inside.
Who maintains your rules today?
If the honest answer is nobody, that's the most common reason savings performance flattens.