Client Spotlights

Client Spotlight: Physicians Medical Group of Santa Cruz County

Tuesday, April 2nd, 2013

Physicians Medical Group of Santa Cruz County (PMG) wins bragging rights for the highest claims per hour processed by a SymKey for EZ-CAP client! PMG’s SymKey processing just keeps picking up speed from 2,880 claims per hour in 2011 to 3,151 claims per hour in 2012, with a high volume of claims pouring through SymKey 1.31 for EZ-CAP 5.x on a daily basis. This speed is unprecedented, even for SymKey clients!

“PMG has been using SymKey for over four years and has consistently experienced extraordinary speeds. This can be attributed to their fine-tuned IT infrastructure that so readily supports both EZ-CAP and SymKey. We at HCIM have always been quite impressed with their systems and IT staff,” said Tom Streeter, HCIM’s SVP, Product Solutions.

How PMG uses SymKey to automate claims adjudication

“We are always seeking ways to improve time management in this constantly evolving environment of medical claims administration. Shifting common edits to be run by SymKey supports the more efficient use of claims staff time, which can be applied to the development of new scripts and review of complex claims. SymKey has been a valuable tool,” said Faye Merryman, Claims Supervisor at PMG.

“The primary advantage we’ve found with SymKey has been the ability to have scripts written to auto-adjudicate the most common edits or adjustments. We have a variety of contract designs specific to certain providers/specialties with unique reimbursement methodologies. One example that we are especially proud of is our shared endoscopic base procedure adjustment script that automates the correct calculation of a complex contract scenario that cannot be configured in EZ-CAP,” said Faye.

PMG’s Advice to other SymKey Users

“Include the appropriate staff (claims examiners, analysts, and other involved parties) to review processes with the goal of identifying the redundant, time consuming tasks associated with claims processing. Then they should prioritize the workflow processes to be automated and tackle them one at a time. Write the automated reports, test them, and then move on to the next scenario until the ‘low hanging fruit’ is working well. The next phase is to tackle the more complex, multi-layered processes,” said Cindy Martin, Chief Operations Officer at PMG.

What a great idea!

PMG uses SymKey to add the RBRVS modifier flags (including surgery global days) as a note to each claim. This saves research time during adjudication and also provides a quick reference in case the Provider or billing staff have questions or dispute reimbursement.

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Client Spotlight: PrimaryHealth of Josephine County

Wednesday, December 19th, 2012

Following a successful 30-day trial period, PrimaryHealth of Josephine County (PHJC), formerly Oregon Health Management Services, licensed SymKey 2.0 for EZ-CAP 6.x on Oct. 20, 2012.

“We decided to begin a free 30-day SymKey trial to see if it could speed up our adjudication process by auto-adjudicating more claims. When Greg and Tom came on site to install SymKey and train our team, we were impressed by their depth of understanding of the EZ-CAP system, claims processing, and adjudication. After Greg wrote a number of reports for us, it became clear that our company would benefit from SymKey,” said Maggie Rollins, Director of Operations at PHJC.

During the three-day onsite installation and training period, HCIM’s Product Solutions Team met with PHJC’s claims operations staff to review their claims workflows and develop numerous innovative reports to automate their Professional and Hospital claims adjudication process. SymKey was able to automate the following commonly-encountered scenarios for PHJC:

  • Deny all claims for providers that are not approved by Medicaid (as indicated by a B7 prefix that EZ-CAP adds to their last name).
  • Identify and deny claims with a diagnosis code that is excluded from Oregon Medicaid.
  • Identify claims where the net pay is greater than the billed amount for that line (due to either contract value or copay) and adjust the net pay to equal the billed charges.
  • Calculate the proper contract value for ambulance claims based on the miles traveled by removing the first 10 miles from the contract value as calculated by EZ-CAP (because the first 10 miles are included in the base rate).
  • Search the claim note field to identify the APC contract value that is imported via EDI and move this amount to the line’s contract value.

“SymKey has reduced the hands-on repetitive keying, thus allowing our adjudicators to do what they do best, adjudicate claims! We saw an immediate savings of at least 10 hours per week, which means that our valuable staff is able to allot their time to more in depth projects. As we continue to develop reports for SymKey to run, we’re able to realize even more time savings by shifting work instead of hiring new staff,” said Rollins.

In the two months since they licensed SymKey, PHJC has reported continuing success and is continuing to look for new ways to automate claims processing with SymKey.

“It was great working with Maggie and Aleesa because they were enthusiastic about SymKey from the beginning and immediately understood how it would be of value to their organization. This value was confirmed during their SymKey trial through the realization of significant staff time savings,” said Tom Streeter, HCIM’s Senior Vice President, Product Solutions.

HCIM stands behind its products because a vendor’s success is largely measured by the success of its clients. This dedication to customer satisfaction drives the symbiotic client-vendor relationship that HCIM strives to foster.

“Everyone has been wonderful to work with! Not only was our onsite visit great, but continuing support is timely, responses to our questions are well thought out, and it’s clear that HCIM has our best interest in mind!” said Rollins.

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Spotlight on Choice Medical Group

Thursday, September 27th, 2012

Choice Medical Group signed a 3-year license for the SymKey® 1.31 for EZ-CAP® 5.x Professional Claims module and Virtual Auto-Post™ module in July 2012. Choice originally decided to pursue HCIM’s 30-day risk-free SymKey trial in June 2012 to see if it could help them to auto-adjudicate Professional claims and reduce their manual processes. They decided to license SymKey after they saw how fast it processed their claims and realized that they’d be able to do more with less staff and greater accuracy.

“My favorite SymKey feature is how fast Symkey auto-adjudicated thousands of claims in an hour according to our specific needs. We saved at least 1-2 FTEs and expect to realize additional cost savings when we’re able to schedule our reports,” said Christina Ortiz, Claims Auditor at Choice Medical Group. “Virtual Auto-Post™ saved lots of time by not having to review every single CCI edit pulled by Virtual Examiner/Virtual Reporter – SymKey automatically applied the adjustment reason codes and denied claims as instructed.”

At Choice Medical Group, the claims team endearingly refers to SymKey as a person. “SymKey’s an asset to our team and is really an ideal employee because it’s incredibly efficient, always does what it’s told, never calls in sick, and won’t ever quit on us. SymKey has allowed us to automate a high volume of claims so our processors can focus on higher priorities and more complex tasks,” said Blair Bryson, IPA Administrator at Choice Medical Group.

“It’s been an easy weekly check run for me,” said Myrna Javier, Claims Manager at Choice Medical Group.

“We’re very satisfied with SymKey and would like to note that Greg Merica has been very helpful and is always available when we need his assistance,” said Ortiz.

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Spotlight on Desert Oasis Healthcare (DOHC)

Tuesday, June 19th, 2012

After a successful 30-day risk-free trial, Desert Oasis Healthcare (DOHC), a subsidiary of Heritage Provider Network, Inc., licensed the SymKey® 2.0 for EZ-CAP® 6.x Virtual Auto-Post™ (VAP) module on May 1, 2012. VAP automates the posting of PCG Software Inc.’s Virtual Examiner®/Reporter® (VE/VR) claims recommendations into the EZ-CAP® system. “We were looking to increase examiner production by having edits automatically applied and processing notes posted to the claim,” said Lisa Giminez-Kerstetter, Claims Supervisor at DOHC.

“SymKey Virtual Auto-Post freed up examiners from having to manually enter adjustment codes by having VAP do the work. VAP is fast and accurate. Efficiency is the name of the game,” said Clare Abadie, Claims Director at DOHC. Prior to VAP, DOHC staff spent 60-75 hours per week posting VE/VR recommendations into EZ-CAP. Now their manual edits only take 10-15 hours per week. That means they’re performing the same processes of posting VE edits with 81% less staff hours. “It is AWESOME, and everyone that we have worked with at HCIM has been accommodating,” said Jeanna Erdahl, Claims Examiner at DOHC.

DOHC expects to realize additional time savings through further utilization of VAP as they identify additional scenarios they can automate. “The more innovative we are, the more we realize how SymKey can be utilized,” said Clare Abadie. “We have a new saying around DOHC, ‘How did we ever live without SymKey Virtual Auto-Post?’”

DOHC first licensed the SymKey for EZ-CAP Professional Claims and Payment Processing modules in 2004. In 2011 alone, DOHC processed nearly 165,000 claims with SymKey and saved them MANY staff processing hours – and that was before they licensed the Virtual Auto-Post module. “SymKey’s abilities contribute to the success of the department. We LOVE our Symkey and the people behind the product. The customer service is outstanding – they are responsive, helpful, accommodating, friendly, generous with their time and knowledge, and innovative,” said Clare Abadie.

“SymKey is my very best friend. Without SymKey, it would be more difficult to maintain an eight day inventory with current staff,” said Brooke Yates, Claims Data Specialist II at DOHC. Clare added, “SymKey makes life easier by adding memos and notes, applying adjustment codes, correcting information that was in-loaded incorrectly, adding authorizations and case numbers, adding and/or removing copays, copying claims for adjustments, etc.”

“Desert Oasis Healthcare has been a delightful client to work with over the past 7+ years. Their staff has been tremendously enthusiastic about SymKey, declaring it the most productive claims processing tool. They continually look for new ways to use SymKey, through the batch processing of Professional claims and most recently with Virtual Auto-Post. It’s been wonderful working with Clare, Brooke, Lisa, Jeanna, Scott and others there,” said Tom Streeter, HCIM’s Senior Vice President, Product Solutions.

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PSW Seeing 3X ROI with SymKey for EZ-CAP

Thursday, September 29th, 2011

Olympia-based Physicians of Southwest Washington (PSW) licensed the SymKey® for EZ-CAP® Professional and Hospital Claims modules for a three-year licensing period in August 2011, after a successful 30-day Risk Free Trial. Here’s what Tamra Ruymann, Claims Manager at PSW has to say about SymKey:

Return on Investment

“SymKey’s price tag was unbelievable! I didn’t think a small company like ours would be able to afford it, but the cost was so reasonable and the ROI was just amazing. I’m seeing a 3x return on my investment!”

Implementation

“The set-up and implementation was painless. When you said it would take three days to implement and move to production, I didn’t believe it. I was a project manager for large IT projects with the State of Washington and have never experienced such a seamless and short implementation. Instead of spending a week in training and weeks testing, we were live in three days.”

The Value of Automation

“We were initially only interested in the SymKey for EZ-CAP Professional Claims module because we had so many simple Professional claims to process that didn’t require the expertise of a claims processor. I knew that SymKey would save us a lot of time in manual work, and it did! But our Hospital claims were a different story – our custom interface tool passes data from EZ-CAP to our third-party MedAssets APC pricer and then exports the data to a spreadsheet so we can manually process each Hospital claim. I didn’t think that process could ever be automated, but it took HCIM only a couple hours to build a custom report for transferring data from the spreadsheet to SymKey for auto-pricing. This workaround saves a claims processor two days every week in Hospital claims adjudication, which allows for more time for other tasks. And since we were already licensing the Professional Claims module, the Hospital Claims module was half the price! I couldn’t believe the value.”

Minimizing Costs

“At our rate of growth, we’ve needed to hire more claims processors every year and I was actually down a claims processor when we started our SymKey trial, but our productivity has improved so much with SymKey that we don’t need to hire any new claims processors at this point. Because SymKey can handle all the claims we throw at it, we’re able to grow our business with a reduction in claims staff hiring.”

Operational Advantages

“Since we began using SymKey for EZ-CAP to process our Professional and Hospital claims, our turnaround time has improved noticeably. And SymKey’s a great tool for out of the ordinary claims processing projects. I’ve already used SymKey’s “Create Exact Claim Copy” scenario to reprice lists of claims at a line level – this saved a lot of time because many of the claims were multiple files and the manual process would have been very time consuming. SymKey also catches all our hard duplicate claims and pends them for review, which is fantastic.”

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SymKey Saves the Day at NAMM-IL

Wednesday, July 13th, 2011

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.

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