SymKey® for EZ-CAP® versions 1.20 and later include a built-in Batch Processing module that opens up the power of the SymKey® processing engine by allowing users to create their own scenario actions that can directly update nearly any field within an EZ-CAP® claim.
Many clients have unique provider contracts in which the specific pricing either is not possible to automate or is not practical to enter as a fee schedule for a contract in EZ-CAP. An external pricer for DRG or APC is a very common example of this, and fee schedules that are frequently updated like NDC codes are easier to maintain in an external source.
Previously, a process to update the claim line Contract Value field was not available in the SymKey standard scenario actions. However, with the power of Batch Processing, it is now a simple task to create a report/query that links the claim and its line level CPT, HCPCS, DRG, or Revenue code to an external database and obtain a contract value amount that can be applied in a claim detail line value. If necessary, these reports can include criteria for dates, providers, healthplans, specialties, benefit plans, or just about any other desired identifier. Furthermore, if a case rate is needed, all other claim lines can be given an overriding contract value of $0.00 and the appropriate adjustment reason code applied.
The report/query would create a SymKey batch file with Claim Number, Line Number, Contract Value, and any other claim or line level fields that may need to be updated. SymKey Batch Processing would then insert the desired Contract Value into the EZ-CAP claim line(s) and save the claims.
SymKey Batch Processing is a powerful toolset. This additional module add-on was designed and built for advanced users, but for those clients without enough technical familiarity or a high comfort level in report design. HCIM has technical resources to assure that claims are modified as intended and the results are accurate and consistent. To learn more about Batch Processing or repricing contract values, please call 888-454-0202, ext. 2, and an HCIM business analyst will be happy to assist.
Tags: Business Process Automation, SymKey, SymKey Batch Processing