HCIM

The Problem

North American Medical Management of Illinois, Inc. (NAMM-IL) was recently impacted by a retroactive fee schedule change that involved processing over 300,000 claims on top of their current workload! A project of this magnitude threatened to bring their normal day-to-day operations to a standstill as staff would’ve had to pour thousands of hours into reprocessing the claims.

The Solution

Bonnie Mezzano, Director of Claims at NAMM-IL, reached out to HCIM and requested two SymKey for EZ-CAP limited duration seat licenses to help recreate and reprice the 300,000+ claims resulting from the retroactive fee schedule change. Instead of taking several months for their staff to adjust the claims, they set up a SymKey scenario to recreate and adjust the claims in a matter of weeks.

What NAMM-IL’s Claims Staff Has to Say

“When our fee schedules were recently updated for 2011, we were faced with the enormous task of recreating and repricing nearly 150,000 claims. Because we did not want to inflate claims utilization, we could not reprocess each detail line in a single step – pay new contract amount and adjust out the previously paid amount. For each claim to be reprocessed, a reversal and a positive claim were created. Thus, 150,000 claims became 300,000 claims! We worked with HCIM to develop scenarios for this process. Since we didn’t want to pay an item that was denied on the original claim, HCIM also helped develop a script to ensure that if a detail line was denied on the original claim, it was also denied on the repriced claim. Without SymKey’s help, completion of the project in a timely manner would have been near impossible. Now, if only SymKey could do the review and post the claims as well!” – Bonnie Mezzano, Director of Claims

“The claim department was presented with a monumental task. Our Fee Schedules were updated in the last quarter of 2010 and beginning of 2011. We were faced with the question: How will we be able to reprocess over 300,000 claims? It would take thousands of staff-hours just to enter all these claims, not to mention the auditing claims for accuracy of copay, eligibility, coding, etc. SymKey recreated the 300,000 claims for us so that our focus was on auditing the repricing payments. Thank you SymKey for all the hours you saved us.” – Karen Cherone, Claims Supervisor

“SymKey has been a big help with the re-pricing of claims for the new rates for 2010 and 2011. Because of the separate reversal and repricings, the project grew to over 300,000 claims. With SymKey we were able to create a negative and positive batch of claims in order to complete the project. It would have taken an adjustor weeks to do what SymKey did in just a few days. SymKey has been a great asset to the department.” – Thelma Simpson, Claims Supervisor

“SymKey was very instrumental with the volume we encountered. Being able to change statuses was one of the key steps for our review process. This work around enabled us to block our claim categories and review without interfering in our regular claim process. SymKey has been a tremendous help! SymKey made the impossible possible!” – Marina Nuñez, Claims Supervisor

About SymKey Limited Duration Licenses

Like NAMM-IL, all SymKey clients can license additional SymKey seats on a project-by-project basis to tackle large tasks without interrupting their current workload. This has proven to be a cost-effective method of claims processing because it eliminates the need for hiring and training temporary claims analysts to spend months doing what SymKey can do in days or weeks.