Smart Data Solutions Tackles Prior Authorization Challenge with Basys.ai
Smart Data Solutions, a leader in healthcare process automation, faced a challenge common across the healthcare industry: streamlining the prior authorization process to meet stringent regulatory requirements while ensuring patients receive timely, appropriate care and coverage decisions.
Prior authorizations have long been a bottleneck in healthcare delivery. With CMS mandates requiring increasingly fast turnaround times, there is growing need among payers and care-delivery organizations for solutions that can accelerate decisions without compromising clinical judgment.
For Smart Data Solutions, the answer came in late 2024 through a strategic partnership with Basys.ai, whose agentic AI platform offered a breakthrough approach to clinical rules evaluation - the process where health plans determine whether proposed treatments meet coverage requirements and member needs.
Smart Data Solutions was already well-established in healthcare automation with over 500 customers, including health plans and third-party administrators (TPAs). The company built its reputation turning unstructured healthcare data into actionable information.
According to April Gill, Smart Data Solutions' chief commercial officer, the company's offerings include a portal enabling automated workflows for claims processing, appeals, health-risk assessments and other mission-critical documents. The portal helps healthcare personnel manage prior authorizations queued for clinical review, but Gill said the company wanted to add technology to boost effectiveness and efficiency.
Since clinical decision-making wasn't the company's core competency, Smart Data Solutions explored the market for technology partners. Then they found Basys.ai.
"We appreciated how Basys' technology executes the clinical rules evaluation - specifically, how they determine whether a prior authorization should be approved or sent through for further evaluation by a clinician," Gill said. "It just made sense. It clicked."
"And we also line up well philosophically," she added. "We look for partners who share our goal to make healthcare more efficient using technology and to deliver better outcomes. And Basys has that."
According to Amber Nigam, Basys.ai's chief executive, the company understood early on the critical importance of training its agentic AI on comprehensive and reputable data sources, leading them to build partnerships with Mayo Clinic and Eli Lilly, among others. Leveraging that data, Basys trained its algorithms on more than 1 billion policy combinations and anonymized clinical information from more than 25 million patients.
Its partnership with Smart Data Solutions leverages each company's strengths in a seamless workflow. Smart Data Solutions handles document intake, data capture, and data management. When a prior authorization request arrives, Basys.ai's technology retrieves relevant patient information from providers - including medical documentation, charts, and lab reports - and generates a longitudinal picture of the patient's overall health.
Because Basys' technology encodes the payer's policy details, it understands coverage nuances as they relate to specific health conditions, comparing the two data sets to quickly render coverage approvals. "We also explain the rationale in clear language, with hyperlinks to the key policy criteria or clinical notes," Nigam said, "so payers, providers and patients can follow the logic of the decision."
Notably, Basys.ai's technology either automatically approves prior authorization requests or moves cases to clinicians for further evaluation. Both companies believe clinicians - not algorithms - should ultimately decide if treatments are inappropriate for patients.
By eliminating 50-60 percent of the decision-making process through reliable auto-approvals, Basys.ai's technology helps payers significantly improve speed and efficiency of prior authorization processes, preventing unnecessary delays in patient care.
Smart Data Solutions began offering its "Intelligent Prior Authorization" solution early this year to current and prospective customers, generating significant interest among clients, including major payers and TPAs like Custom Design Benefits, Cincinnati's largest independent, full-service Third Party Administrator of self-funded health benefit plans.
Steve Fiorino, Custom Design Benefits’ VP of Operations explains: "We see firsthand how critical it is to modernize processes that directly impact providers and patients. Our commitment to innovation means we're continuously exploring new models and technologies - especially in areas like prior authorization, where even small improvements can have a big impact. We're proud to lead with a mindset that values transformation, efficiency, and better experiences across the care journey."
Gill noted the company is in the final stages of beta integration to ensure optimal performance, and she is confident health plans and TPAs will adopt the technology. She said many health plans struggle with prior authorization timing requirements, facing two suboptimal choices: approve requests without proper review, potentially affecting patient care, or face increased operational costs and penalties imposed by CMS or state regulators.
With Intelligent Prior Authorization, Gill said, health plans can reliably auto-approve appropriate cases while directing complex cases to clinicians, ensuring timely, accurate decisions.
Smart Data Solutions sees this partnership as the beginning of broader transformation. Their existing Intelligent Medical Record product, which can distill 1,000-page medical records into focused summaries, already helps users achieve 50% greater efficiency in medical records and bill reviews. By leveraging Basys.ai's agentic AI capabilities, they're tackling one of healthcare's most persistent challenges.
"We're excited about the potential to leverage Basys' AI technology to help healthcare solve what has been an extremely challenging problem to address," Gill said. "Given the strengths of our two platforms combined, and the breadth of Smart Data Solutions' existing customer base, we believe the impact of this partnership could ripple quite quickly across the industry."
Nigam agreed. "Payers, clinicians and patients deserve a better prior authorization experience - and not just incremental improvement," he said. "What we've built with Smart Data Solutions represents a major leap forward, and we're proud to make it happen."