HCIM

SymKey

Linda Deaktor, Director of Medical Affairs, MedPOINT Management
After learning about SymKey from the MZI EZ-CAP sales staff, we arranged an on-site demo early this year. By the end of the presentation, we were negotiating with HCIM on the purchase of the SymKey for EZ-CAP Professional Claims module and Virtual Auto-Post module, as we quickly realized the benefits of automating parts of our claims adjudication process. During implementation, HCIM’s staff helped us customize the batch processes and scenarios to match our claims rules. We have been using SymKey since April 2010 and are very pleased with the results. HCIM’s staff has even been readily available to answer our questions after hours and on the weekends when we do some of our claims processing.

Tammy Anderson, Claims Manager at Managed Care Systems (MCS)
I’m watching a SymKey scenario right now. It just keyed 62 claims, which is equivalent to 1,151 claims an hour. I just tease my analysts and say, “Let’s see you key that fast.” On average, my claims analysts process around 200 claims a day. They’d be superhuman if they could key half as fast as SymKey! But my analysts love using SymKey because it boosts production, reduces errors, and saves them from having to do a lot of tedious manual work.

Chuck Weber, SVP of Operations at CareMore Medical Enterprises
Using SymKey, we foresee a 10-20% reduction in the cost of processing a claim, because when SymKey automates our claims adjudication process, it takes the burden away from our full-time staff.

Mary Kouvelis, Senior Operations Director at North American Medical Management of Illinois, Inc. (NAMM – IL)
After PCG Software referred us to HCIM and we learned about their products, we signed up for the 30-day risk free trial of the SymKey for EZ-CAP Professional and Hospital Claims modules. During the trial, we realized that SymKey gave us the capability to increase functionality and to move claims more efficiently and productively. We made the decision to license SymKey after the successful trial period. In the few months since we licensed SymKey, we’ve already seen a 50% decrease in the amount of time supervisors have to prepare for check runs and we’ve achieved a higher level of productiveness and effectiveness in our claims processing. We currently run about 80% of our claims through SymKey at one point or another, and since SymKey can automate our processes, it will allow NAMM – IL to grow without having to hire and train more staff.

Tom Middleton, Senior Director, Claims, at Physicians United Plan HMO (PUP)
PUP needs to reduce our administrative costs and by utilizing the SymKey for EZ-CAP Professional Claims module and Virtual Auto-Post module, we eliminate processing costs on those claims. SymKey is a great product and now we are testing the Hospital module which I fully expect that we will license.  My relationship with HCIM has always been positive as they are truly partners with us in resolving operational issues. They are excellent to work with and always go above and beyond to meet our needs.

Cindy Martin, COO at Physicians Medical Group of Santa Cruz County (PMG)
We have been able to move many of our homegrown solutions into the SymKey product, which ensures that the rules are applied accurately and consistently. We will soon be expanding the use of SymKey into more auto-adjudication areas, and we are confident that it will continue to improve our productivity.

SymKey Scenario Actions

Tammy Anderson, Claims Manager at Managed Care Systems (MCS)
The Reprocess/Pend scenario has already paid for itself by reducing the number of hours a claims analyst must spend to reprocess claims due to contract changes or other changes. For instance, when we have had 200 claims that we had to reprocess, it would take a claims analyst up to two days to complete them, wherein SymKey could process it in less than an hour. After SymKey runs the Reprocess/Pend scenario, all the claims analyst has to do is check it for accuracy and release the claim.

The Type of Service P to H scenario is probably our second best SymKey scenario, simply because it can save us real money by correcting overpayments. With P to H, SymKey changes a claim’s type of service from P (professional) to H (hospital) and then reprices all of the claim lines, which allows the claim to be processed correctly and paid at the lower hospital site rate. We used to do this manually, but it was time consuming and we missed a lot of overpayments due to an incorrect type of service. We used to catch overpayments on the audit side, but it caused confusion and took even more manual staff hours.

The Hard Dup/Not a Dup scenario is a valuable tool for us, because we have providers that are very impatient. If they don’t see their claims processed immediately, they automatically resubmit them for processing. On any given day, we probably see anywhere from 20 to 100 hard duplicate denials. SymKey runs the selected scenario, finds the duplicate claims based on criteria that’s been set for the program, and then denies the duplicate and sets it on its way, so nobody has to look at it. Before SymKey, an analyst had to manually search for duplicates claims messages in the system and then correct them, wasting valuable time. Even then, we always had the potential of missing hard duplicates, and then we would have to recover the money.

MCS currently runs 15 different SymKey scenarios, and we have aspirations to add more. We ask our analysts what they do the same way every day. If it can be automated by a system, then we work with HCIM to have it developed. Our HCIM representatives are great – they can deliver product enhancements really quickly. 

ScanClaims

Janice Jones, UM Director at Managed Care Systems (MCS)
The ScanClaims UM Workflow allows us to maintain our authorizations in an electronic format. For the first time, during the months of July and August, we ordered no office supplies in our department! No paper, no post-its, no pen refills, no paper clips, no file folders.

HCIM was very patient with our exceptions to every process and helped us to find automated solutions to problems that we thought we would just have to live with. This was a true collaboration between HCIM and our IT Department and together they created a workflow that is so comfortable to the staff that acceptance was immediate. This is very rare in my experience and I’m ready for Phase II.

Eric Blomberg, Claims Supervisor at Managed Care Systems (MCS)
If we didn’t use ScanClaims, we would have to hand-key claims, which would result in decreased production, a slower turnaround time, and maybe even difficulties with our health plans and Providers.

Tammy Anderson, Claims Manager at Managed Care Systems (MCS)
MCS is very pleased and satisfied with the quality and ease of use of ScanClaims and Claims Manager. We enjoy working with the HCIM team, because their customer service is excellent and we always get a prompt response.

Janice Jones, UM Director at Managed Care Systems (MCS)
We have seen considerable improvement in productivity in the QNXT system with the use of SymKey. For the first time, authorization requests that we have identified as “auto auth” are actually going in clerk-free. Since the middle of July we have lost two FTEs and have two additional employees on leave and have so far been able to absorb the workload.

Brent Boyd, Claims Supervisor at Managed Care Systems (MCS)
In addition to the FTEs mentioned, there are hires we are averting and had budgeted for.  We’re growing without adding positions for this process.

Eric Blomberg, Claims Supervisor at Managed Care Systems (MCS)
ScanClaims for UB-04 has made our process more efficient, since claims analysts can now process claims rather than key claims. 

Consulting Services

Frank Campbell, VP of Healthcare Systems and Provider Data Management at Bravo Health
Over the past 18 months, Bryan Richardson has been our QNXT “go to guy.” His QNXT Professional Certification has proven time and again that he truly understands the entire QNXT application. His QNXT experience and extensive managed care knowledge allows him to properly analyze and then configure QNXT to work with our plan’s unique business practices. In terms of time and money, it is extremely valuable to our organization to have a resource like Bryan on site to address the configuration challenges presented by our staff. He articulates solutions in easy to understand terms and is always open to mentoring our staff on proper QNXT configuration solutions.

Specifically, Bryan has supported service pack and 3.4 upgrade testing, post-implementation cleanup, trained my staff how to triage claim pricing problems, and reverse engineered the QNXT payment process so we could reconcile provider accounts. Bryan has supported my department plus Configuration, Finance, Health Services, Provider Data Management, Training and IT. He has handled everything we have thrown at him and offered suggestions for improvement besides.

I would recommend Bryan Richardson to other organizations, based upon his wealth of managed care experience and his demonstrated knowledge of QNXT, which comes from his practical application experience and his QNXT Professional Certification training.