Insurance
Claims, member and policy systems modernized and connected, including the Medicaid file process where our team found $16M+ in lost revenue.
Health plan
$16M+
A routine Medicaid code update that surfaced $16M+ in lost revenue: in lost Medicaid revenue returned to the health plan
Hired to add a state-mandated code to a health plan’s nursing facility file, our team noticed the process was mishandling records. The plan confirmed it, filed corrections and recovered $16M+.
Health plans and Medicaid managed care
Claims and assessment platforms, member apps and the data pipelines behind them, for a health plan we have supported for more than ten years.
Payers and benefits companies
Member, eligibility and benefits data connected across the systems that pay claims and serve members.
Claims and recovery services
Claims data brought together and checked, so recovery and reporting teams can trace each number to its source.
Commercial insurers
Application, integration and data engineering work for carriers that run their own IT teams.
Health plan · Medicaid data
While implementing a state-mandated code update for a Medicaid health plan, our team noticed its nursing facility file was mishandling records. The plan filed corrections with the state and recovered $16M+, and we rewrote the process to stop the loss.
Retroactive eligibility changes arrive from the state
The NFLOC historic file records each member’s level of care
The file sent records the state rejected: members not eligible on key dates, duplicates and updates for records the state did not have
We showed the plan where the file was losing revenue, and the plan sent correction files to the state
Lost Medicaid revenue came back, and we rewrote the process in SQL Server
$16M+
in lost Medicaid revenue returned to the health plan
Our insurance services
Most insurance work starts with a system already in production: a claims process losing revenue, a member portal that’s hard to maintain or reporting that takes weeks to reconcile.
Claims and assessment platforms
We rebuild the platforms that create claims-ready records, so assessments, eligibility and billing data line up before a claim is filed. For one Medicaid health plan, our team found a nursing facility file mishandling records during a state-mandated update; the plan recovered $16M+ and we rewrote the process.
Member and provider apps
Secure member and provider experiences for claims status, benefits, care and documents, including single progressive web apps that replace separate mobile and portal builds and keep shipping after launch.
Claims and member data platforms
Claims, eligibility, member and provider data brought into one governed platform on Microsoft Fabric, Databricks or Snowflake, with quality checks that catch errors before they reach a claim or a regulator.
Policy and core system integration
We connect core administration, billing, CRM and provider systems through APIs, and move brittle legacy middleware onto services your team can support, without a disruptive cutover.
AI on claims and member data
AI on claims and member data has to be explainable to an auditor. We build it on governed data, with access limited by role and a person in the loop wherever a decision touches a member or a payment.
How we deliver
Monitoring, fixes, updates and enhancements on a monthly plan, with response times set by priority from P1 to P4.
Step 1
A scoped project, engineers added to your team or a direct hire. We help you decide.
Step 2
Onshore, offshore or a mix, matched to your timeline, stack and budget.
Step 3
We work within your environments, your review process and your compliance rules.
Step 4
Regular demos and check-ins, with room to change course when the program changes.
Case studies
HealthcareA 22-month React Remix PWA for one of the largest Medicaid managed care organizations, replacing the separate mobile app and member portal with one app. Smart Data is the engineering partner.
Medicaid · Home careOhio’s largest healthcare plan provider retired a costly third-party system for a custom Medicaid waiver platform, built by Smart Data.
Questions
Mostly health plans and Medicaid managed care organizations, plus payers, benefits companies, claims and recovery services firms, and commercial insurers with their own IT teams.
Yes. We build on or connect to the systems already in production: claims, assessment, eligibility, billing and member platforms. We modernize in stages so the business keeps running.
After the data is ready. We start with data quality and governance on claims and member data, then pilot AI with defined access and a human review step before anything reaches a member or a payment.
Yes. Through managed services we own monitoring, support and upgrades, with P1 to P4 response times. When you need more hands, our engineers work inside your team.
Industries
Patient, pharmacy and clinical data systems held to HIPAA, including where AI is allowed to touch them.
Clients include
ERP, shop-floor and supplier data on one platform, so plant reporting and finance reporting reconcile.
Clients include
Order, inventory, credit and customer data connected across portals, branches and the platforms behind them.
Clients include
Bank data platforms, reporting that holds up to an audit and managed support for the financial systems the business runs on.
Clients include
Next step
Tell us what runs today and what it is costing you. Here is what happens after you reach out.
What runs today, which rules it answers to and what has to change first.
Scope comes from your systems as they are, before anything is priced.
Covering scope, team, approach and price.
SQL Server
React
TypeScript
.NET Core