HCIM has developed two new standard scenario actions for incorporation into the SymKey® for EZ-CAP® v. 1.31 Professional and Hospital Claims modules, which will add the functionality to accurately copy or reverse a claim, with or without repricing the contract values in the claim detail lines.
Create Exact Claim Copy Scenario Action
With the new “Create Exact Claim Copy” action, SymKey will create an “exact” copy of another claim (the header and detail lines with Adjustment Reason codes and amounts will be copied, memos can optionally be copied, processing statuses and notes will not be copied). SymKey can copy claims in status 1, 2, 3, 5, and 9, and will not reprice the new claim unless it is directed to by another selected scenario action.
This action can be combined with any other actions in the Professional and Hospital Claims modules, except for the “Claim Note Only,” “Delete,” and “Reprocess/Pend” special actions. With this new functionality, it will be easy to copy and re-process paid claims within a single SymKey batch. All selected scenario actions aside from the “Create Exact Claim Copy” action will only be applied to the newly copied claim, leaving the original claim untouched.
This scenario action will be useful for splitting claims with a DOS that spans a benefit or contract renewal date, or to appropriately divide financial responsibility.
Reverse Scenario Action
With the new “Reverse” action, SymKey will negate the quantity of a line (Billed Charge and Contract Value) and reverse benefit accumulators. It will also reverse all other amounts on the line (positive amounts become negative and negative amounts become positive), resulting in a reversed (negative) net pay. SymKey can either reverse all lines or specified lines on the claims, with some restrictions.
This action can be combined with any other actions in the Professional and Hospital Claims modules, except for “Claim Note Only,” “Delete,” “Reprocess/Pend,” “Copay Allow Only One…,” and “Copay Adjust Negative Net Pay.” SymKey is able to reverse claims in status 1, 2, 3, and 5. SymKey is also able to reverse previously paid status 9 claims by copying them first (when combined with the “Create Exact Claim Copy” action).
If the “Re-price Claim Lines” action is not selected, SymKey will ignore EZ-CAP’s automatic re-price when the quantity is made negative and will enter the original Contract Value, Deductible, and Copay values in negative form.
This scenario action will be a helpful tool in correcting payments to incorrect providers or members.
Tags: SymKey, SymKey Releases