TALON and Smart Data Solutions expand UAPA™ repricing in SDS clearinghouse

TALON and Smart Data Solutions (SDS) extended a partnership that already used TALON’s Universal Repricer within SDS’s EDI clearinghouse workflow. The update expanded where TALON’s pricing intelligence could be applied before claims adjudication, using SDS connectivity already in place.

The companies said the integration targeted repricing during the claims process to address limits of legacy fee schedules and manual repricing workflows. They described Reference-Based Pricing (RBP) and traditional network discounting as approaches that can diverge from commercial market rates, and they tied UAPA™ to payment anchored in provider-accepted prices derived from weighted average payer-negotiated rates.

In the expanded setup, TALON’s Universal Repricer routed EDI 837 transactions processed via batch SFTP into a repricing step using UAPA™ rates, including rates TALON had configured from payer-published in-network negotiated machine-readable files. The workflow returned repriced claims and included claim audit functionality to flag pricing anomalies before adjudication. The partners also cited compatibility with “16+ claims administration platforms” integrated with TALON’s platform.

Mark Galvin, Founder and CEO, TALON, said, “Healthcare has never had a trusted price signal. UAPA™ changes that. By tying payment to what providers already accept, we improve first-pass claim acceptance, materially reduce balance-billing risk, and compress costs to support employer growth. Every functional market operates on transparent pricing with regulated exchanges, settlement, and clearing that are auditable and provable. American healthcare consumers, the self-insured employers who bear the majority of non-emergent costs, and the providers who deliver care deserve nothing less. Extending UAPA™ deeper into SDS's clearinghouse is how that price signal reaches the market at scale.” April Gill, Chief Growth Officer, Smart Data Solutions, said, “Our work with TALON continues to deliver real change for our the healthcare industry, and we're excited to bring UAPA™ and Universal Repricer to continue this transformation. Embedding a transparent, market-weighted price signal into our workflow gives TPAs and payers measurable gains in pricing accuracy, plan performance, and member satisfaction.” The partners described the next phase as scaling adoption so additional health plans, TPAs, and self-funded employers could apply repricing inside their existing clearinghouse workflow.

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