What JMS and Associates does

JMS and Associates is a privately held information-technology services company headquartered in Farmington Hills, Michigan, founded in 1975 and operating with a headcount in the 251-500 range. The firm is described as providing claim administration staffing and automated claim payment solutions, indicating a business model that combines outsourced claims operations personnel with software-driven payment automation for payer-side and TPA-side clients.

The company's service mix — staffing plus automated claim payment — positions it as a hybrid operations-and-technology vendor in the healthcare claims value chain. Its longevity (50 years since incorporation) implies sustained client relationships and accumulated domain knowledge in claim administration, though the source material does not disclose customer names, contract structure, pricing, geographic reach beyond the US, or specific product/technology architecture for the payment automation layer.

The leadership team is small and operationally oriented: dual CEO seats (Jon M. Shoats, Frank Gigliotti), founder Chuck Agrusa, CIO Daniel Feng, VP of Operations Judi Bean, and Director of Operations Lisa Leidal. No information is disclosed on private equity or venture backing, funding history, M&A activity, financial performance, segment mix, or named enterprise customers. As a result, the depth of strategic, financial, and competitive analysis is constrained by data availability.

Name

JMS and Associates

Legal name

Smart Data Solutions

Website

https://jmsassoc.com

Company type

Private

Founded year

1975

Operating status

Operating

Headcount range

251–500 employees

Short description

JMS and Associates is a Farmington Hills, Michigan-based private IT services firm founded in 1975 that provides claim administration staffing and automated claim payment solutions to payer and TPA clients in the United States.

Ownership category

akta.pro rank

Product category

Healthcare Claims Administration and Automation

NAICS

Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (51821), Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (518)

SIC

Services-Computer Programming, Data Processing, Etc. (7370), Hospital & Medical Service Plans (6324)

akta.pro primary industry

Payer-Provider Data Exchange (X12, prior auth, claims/clinical attachment) (HLACABAK)

akta.pro secondary industry

Document Management Systems (DMS) (HDAEAGAA)

Keywords

• Claim administration staffing
• Automated claim payment solutions
• Healthcare claims processing
• Claims workflow automation
• Healthcare IT services

Headquarters

HQ city

Farmington Hills

HQ country

United States

HQ region

North America

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Technology or R&D, Operations, Infrastructure, Marketing or Sales

Revenue model

1. Healthcare Operations Automation Services: Provides AI-native automation platform and services to healthcare payers for workflow orchestration, claims processing, clearinghouse services, and data management. Services include front-end processing, EDI clearinghouse, scanning, imaging, OCR, mailroom, automated routing to PPOs/networks, pre-adjudication edits, and custom IT services.

Go-to-market motion1 record

Distribution channels3 records

Marketing channels6 records

Core offering

JMS and Associates provides claim administration staffing alongside automated claim payment solutions for healthcare payers and related entities. The firm combines people-based claim administration services with technology-driven automation that captures inbound documents, processes claims, performs clearinghouse and EDI routing, manages prior authorization, handles provider data, indexes medical records, and simplifies enrollment. The offering is delivered through direct engagement with payer operations teams across the United States, with solutions deployable individually or as a unified platform.

Product overview

Smart Data Solutions offers an AI-Native Healthcare Automation Platform that unifies data intake, intelligence, and workflow orchestration across payer operations. The platform consists of multiple integrated modules including Digital Mailroom, Data Capture (OCR), Claims Operations, Clearinghouse, Interoperability, Prior Authorization, Provider Data Management, Intelligent Medical Records, and Enrollment Simplification. All solutions work together as a unified system, integrating seamlessly with existing platforms. The core platform features a foundational intelligence engine that validates, structures, and enriches information before it enters downstream systems.

Differentiator

Problem solved

Functional benefit

Products and services

• Claim Administration Staffing People-based claim administration services for healthcare payers and related entities, providing operational staffing to run claim administration workflows and front-end claim processing functions.
• Automated Claim Payment Solutions Technology-enabled automated claim payment solutions that capture inbound claim documents, perform clearinghouse and EDI processing, apply pre-adjudication edits, route claims to networks, and support automated payment workflows for healthcare payers.
• Digital Mailroom Automated processing of inbound claim documents and correspondence to ensure timely and accurate processing, meet filing requirements, and route documents to appropriate downstream processes.
• Data Capture (OCR) OCR and data capture tools to capture, validate, and deliver data from standard claim forms, EOBs, enrollment forms, appeals, and other inbound documents in required formats.
• Claims Operations Business Process Automation (BPA) for health plans, TPAs, PPOs, and other healthcare entities, including pre-adjudication edits, member and provider matching, and automated routing to PPOs and networks.
• Clearinghouse Services Full clearinghouse services including inbound claims processing, outbound remittances, and CAQH CORE compliant claim status and eligibility responses for healthcare payers.
• Interoperability Services Interoperability platform enabling streamlined processes and workflows between multiple trading partners, with CAQH CORE compliant integrations.
• Prior Authorization Automated prior authorization requirements management for the management of medical costs and patient care.
• Provider Data and Contract Management Intelligent automation to cleanse Provider Data without manual effort and reduce potential for errors.
• Intelligent Medical Records Medical record indexing, categorization, and analysis using automation to handle large document sizes and reduce manual administrative work.
• Enrollment Simplification Automated front-end enrollment intake workflow including 834 enrollment hub functionality for commercial products.
• Quick Claim Portal Web-based claims submission portal for providers to submit and process claims via the platform.

Quantifiable outcome

• Reduced manual effort and improved accuracy through AI-native automation
• +3 more outcomes

Named customers3 records

Segments3 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability5 records

Feature10 records

Partnerships

Six partnerships are on record, tiered minor and core.

• AmerihealthminorOthersAmerihealth uses Smart Data Solutions for front-end services including clearinghouse, scanning, imaging, OCR, mailroom, and custom IT services such as file format conversion and transfer for claims processing.
• BCI PartnershipminorOthersBCI partnership claims are processed using Smart Data Solutions' services including automated routing, pre-adjudication edits, and custom IT services for file format conversion and transfer.
• CAQHcoreTechnology or IntegrationSmart Data Solutions is CAQH CORE certified, providing CAQH CORE compliant claim status and eligibility responses as part of their clearinghouse services.
• HITRUST AlliancecoreTechnology or IntegrationSmart Data Solutions maintains HITRUST CSF Certification through partnership with HITRUST Alliance for healthcare security and compliance standards.
• EHNACcoreTechnology or IntegrationSmart Data Solutions holds EHNAC accreditation for electronic healthcare network operations.
• HPA (Healthcare Payer Alliance)coreChannel Partner/ Reseller/ DistributorSmart Data Solutions is a sponsor of HPA Biz, a healthcare payer alliance organization, indicating a strategic channel partnership in the healthcare payer ecosystem.

Scale indicators1 record

Expansion highlights1 record

Direct peers

• Availity: Availity operates one of the largest healthcare clearinghouse and payer-provider data exchange networks in the U.S., offering EDI transactions, eligibility, claims, and provider data management — directly overlapping with SDS's clearinghouse, interoperability, and provider data modules.
• Edifecs: Edifecs specializes in healthcare data interoperability, EDI translation, and value-based care administration for payers and providers — directly comparable to SDS's interoperability, EDI clearinghouse, and payer-provider data exchange capabilities.
• MultiPlan: MultiPlan operates a nationwide PPO network and claims cost-containment services for payers, including automated routing to networks for discount maximization — directly comparable to SDS's PPO/network routing and claims automation use cases.

Broad incumbents

• Change Healthcare (Optum): Change Healthcare, now part of Optum, is the largest U.S. healthcare clearinghouse and revenue cycle network, offering a broad portfolio spanning claims, eligibility, remittance, and AI-powered automation — competing with SDS across nearly every payer-operations module.
• Waystar: Waystar provides cloud-based healthcare revenue cycle and clearinghouse technology to hospitals and payers, with overlapping modules in claims processing, eligibility, prior authorization, and patient intake — a comparable enterprise healthcare automation platform.
• Experian Health: Experian Health offers payer-side and provider-side solutions covering claims management, eligibility, patient access, and data services, and competes with SDS particularly in identity, eligibility verification, and clearinghouse connectivity.
• HealthEdge: HealthEdge offers a modern, integrated core administration and care management platform for health plans, with overlapping focus on payer digital transformation and operational automation — adjacent to SDS's payer-operations layer.
• SS&C Health: SS&C Health provides technology and outsourcing for health plan administration, including claims processing, TPA services, and member management — comparable to SDS's TPA-focused automation offerings and broader payer operations footprint.
• Cognizant (Healthcare): Cognizant provides large-scale IT services and digital transformation for payers and TPAs, including claims processing, data management, and automation — competing with SDS for enterprise payer digital transformation spend.

Emerging players

• Olive AI: Olive AI was an AI-native healthcare automation vendor focused on revenue cycle and administrative workflows for providers and payers — a thematic comparable to SDS's AI-native automation positioning, though currently in operational reset.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat3 records

Key risks2 records

Key highlights6 records

Customer concentration

• Xx.com/jmsassoc
• YouTubeyoutube.com/channel/UCp-LTXSnUBqdQ6CoKuJzlBw
• Facebookfacebook.com/jmsassoc
• LinkedInlinkedin.com/company/jms-and-associates-inc.
• Instagraminstagram.com/smartdatasolutions

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles6 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about JMS and Associates