Author Archive

FAQ: In SymKey, how do I switch the EZ-CAP database to process claims in?

Thursday, July 1st, 2010

Answer: In SymKey® v. 1.30 and later, switching databases has never been easier. Simply click the “Change Database” link in the lower left corner of the SymKey main menu. When the “Change Database” window opens, you will see all databases to which SymKey is configured to connect. Once you select the desired database and click the “OK” button, SymKey will seamlessly switch to your new database. The database that SymKey is connected to will be displayed in the bottom left corner of the application’s window, along with the date and the logged in User ID.

If you do not see the desired database in the “Change Database” window, it may need to be added to SymKey’s EZ-CAP® Database configuration. If you are unable to make this change, please see your administrator or contact HCIM Product Support at support@hcim.com or 888-454-0202, option 2.

FAQ: How do I enable/disable zeroing out the provider contract value for the SymKey Deny scenario?

Monday, June 28th, 2010

Answer: One of SymKey’s global settings allows users to configure whether or not to zero out the contract value when SymKey denies a line in either the Professional or Hospital Claims modules. In SymKey v. 1.20 and later, the configuration of this action is reserved for users with an Admin security level.

To change the setting, click the “Global Settings” link in the “Configuration” section on the left side of the SymKey main menu. Once the “Global Settings” window opens, either check or uncheck the “Zero-out Contract Value when denying a line” checkbox, according to your organization’s business rules.

If you do not have sufficient rights to access SymKey’s Configuration section, please see your administrator or contact HCIM Product Support at support@hcim.com or 888-454-0202, option 2.

FAQ: How do I enable and configure COB checking?

Thursday, June 17th, 2010

Answer: SymKey® allows users to configure the handling of claims with COB (Coordination of Benefits). When EZ-CAP® determines that a member has other coverage, it flags that claim as COB. SymKey can be configured to either pend COB claims for review if the coverage is Primary, pend for review when there is any other coverage, or ignore COB flags. In order to configure or change COB checking in SymKey 1.31 or later, users must have Admin level security rights.

Global COB Checking Configuration
On the left side of the SymKey main menu, click the “Global Settings” link in the “Configuration” section. From the “Global Settings” configuration window, either check the “Check Coordination of Benefits (COB)” checkbox to pend claims that EZ-CAP identified as COB or uncheck the checkbox to ignore all COB flags that SymKey encounters. You can also select the options below that checkbox to “Pend claim if COB and member has other Primary coverage” or “Pend claim if COB and member has any other coverage.”

Batch Level COB Checking Configuration
When “Check Coordination of Benefits (COB)” is enabled in SymKey’s Global Settings, users can still ignore COB pending at a batch level within SymKey’s Professional, Hospital, and Batch Processing modules. When configuring a Professional or Hospital Claims batch, simply check the “Ignore Pending for COB” checkbox in the “Global Options” section of the module. In the Batch Processing module, check the “Ignore Pending for COB” checkbox to the right of the “Source Claim Status” section. When “Ignore Pending for COB” is selected, SymKey will ignore the configured global setting to pend claims with COB for that batch only. Once the “Ignore Pending for COB” checkbox is unchecked or the SymKey claims processing module is closed, SymKey will no longer ignore the globally configured COB Checking setting.

FAQ: How do I configure how SymKey responds to certain EZ-CAP system error/warning messages?

Thursday, June 10th, 2010

Answer: In SymKey® v. 1.31 and later, only Admin level users have sufficient security rights to configure or change how SymKey responds to EZ-CAP® system error/warning messages. From the SymKey main menu, click the “EZ-CAP Messages” link under the Configuration section. This will open a window that shows every message that SymKey has encountered while running EZ-CAP. There are three sections in the window:

The Title section shows which EZ-CAP subsystem generated the message.
The Message section displays the specific EZ-CAP error or warning.
The Action section is a drop-down menu that displays how SymKey will respond to receiving that message and is the only editable area of the window.

If you would like to change the Action for a given message, click the drop-down arrow next to the appropriate action and select one of the two options: Pend or Ignore. When you are finished with your changes, simply close the window.

FAQ: How do I configure or add new SymKey users?

Thursday, June 3rd, 2010

Answer: In SymKey® v. 1.30 and above, the Users link is under the Configuration section on the left side of the Main Menu. The rights to add/change SymKey users is limited to the Admin security role. If the Users link is enabled, then you have sufficient rights to make these changes. Selecting the Users link from the Main Menu will take you to the Users configuration screen. From here, you can add a new user, delete an existing user, or reset a user’s password.

To add a new user, click the “New User” button, enter a User ID, choose an appropriate security role, enter the password in the next two fields, and then click the “Save New User” button to add the new user to the list. To delete a user, highlight the user to be removed from SymKey and then click the “Delete User” button. You will be asked to confirm your deletion. To reset a password, highlight the user in the list and then click the “Reset Password” button. You will be asked to enter a new password for the user.

FAQ: How do I generate the SymKey Hard/No Dup reports?

Thursday, May 27th, 2010

Answer: In SymKey® v. 1.30 and later, click the “Hard Duplicates” link under the Modules section on the left side of the main menu. In the Hard Duplicates Generator window, you will see that the checkboxes for SymKey’s default configuration are preselected. By default, the Hard Duplicates Generator will match the following:

  • Claims in status 1, 2, or 3 (Suspect Claims) received during the past month against claims received at any date that are in status 5, 6, or 9 (Target Claims)
  • Only look at suspect claims where EZ-CAP has marked any line on the claim with a “DUP” flag in the P7 field
  • Suspect claim matches target claim’s header info for:
    • Member ID
    • Vendor ID
  • Every suspect claim line matches a unique line on the target claim by:
    • Service Date From
    • Service Type
    • Service Code
    • Billed Charge

You may further refine the matching criteria by checking the appropriate checkboxes. When you are ready to run the report, click the “Create File” button. SymKey will search for the duplicate claims that meet your criteria and begin building a batch file. Once completed, SymKey will save the new file under C:\SymKey\Files\Source by default. You can then run that duplicates file in the appropriate SymKey Professional or Hospital Claims module and deny them per your business rules. For more information, refer to your SymKey User Guide or contact HCIM Product Support at support@hcim.com or 888-454-0202, ext. 2.

FAQ: SymKey won’t open a batch of UB04 claims – it keeps trying to open EZ-CAP’s UB92 module, which is disabled. Is SymKey broken?

Thursday, May 20th, 2010

Answer: No, SymKey is not broken. There is likely an issue within EZ-CAP’s claim structure, where the UB04 claims that you are trying to open are labeled as UB92 claims in EZ-CAP’s tables. Before SymKey opens a claim, it queries EZ-CAP’s tables on the backend to determine which module it should use to open the claims. Since EZ-CAP is telling SymKey that the claims are UB92 claims, SymKey will not open them in EZ-CAP’s UB04 module. While you are able to manually open UB92 claims in the EZ-CAP UB04 module, SymKey will not do so because once the claims are saved in the UB04 module, they can no longer be opened in the UB92 module. For this reason, SymKey will only attempt to open UB92 claims in the UB92 module. When the UB92 module is disabled for the SymKey user, SymKey will fail against user rights in EZ-CAP.

If you would like to process claims labeled as UB92 in the UB04 module, you can manually open each claim in the UB04 module and save them as UB04 claims. Alternately, you can modify the SymKey user security in EZ-CAP to enable the UB92 module so SymKey can process the claims as they are.

FAQ: How do I view batch report information for an entire month?

Thursday, May 13th, 2010

Answer: From the left side of the SymKey main menu, click the Productivity Reports link in the Reports section. SymKey’s productivity reports are an aggregate of your daily batches, viewable by month, year, or pend reasons, depending on which report you select. The reports allow you to quickly view performance data, claims processed, and most importantly your return on investment (ROI) acheived by the SymKey application. For more information about SymKey’s productivity reports, click here.

FAQ: How do I add or change one of the EZ-CAP databases that SymKey processes claims in?

Friday, May 7th, 2010

Answer: In SymKey® for EZ-CAP® v. 1.30 and later, if your User ID has admin rights, you will see an enabled “EZ-CAP Databases” link in the Configuration section of SymKey’s main menu. Clicking that link will display the current databases that are configured to work with SymKey. To change one of the databases, simply highlight it in the list at the top of the window and change the necessary information that is displayed below it. Once you are finished, click the “Save Changes” button.

If you want to add another database to the list, click the “New Database” button. This will give you the opportunity to choose a name for the database, add a server name and database name, and set EZ-CAP and database connection user IDs and passwords. Once you are finished, click the “Test Connection” button. This will confirm that SymKey can successfully communicate with the database. Once you are satisfied, click the “Save New Database” button.

FAQ: What happens if SymKey stops in the middle of my batch? Can it be restarted?

Thursday, April 29th, 2010

Answer: SymKey® can be interrupted in the middle of a batch for a number of reasons, either by the user pausing the batch or by network issues creating a communication error between it and EZ-CAP®. It can be restarted very easily. When an interruption occurs, providing that you are still logged into SymKey, a message will be displayed asking if you would like to continue the batch. If you click “Yes,” SymKey will start the batch up again. Clicking “No” will close out the batch and SymKey will consider it completed.

It should be noted that when the batch is continued, SymKey will skip the claim that was interrupted. This is designed to avoid another possible interruption, since the issue may have been caused by a problem with that particular claim. SymKey will continue, starting with the next claim down in the batch file. The skipped claim will be listed in the “Unprocessed Claims” tab in the batch reports, along with the reason why it was skipped.