Posts Tagged ‘Business Process Automation’

Automate Routine Tasks to Increase Employee Efficiency

Thursday, October 7th, 2010

HCIM’s SymKey® Kwik Actions™ application increases the efficiency and productivity of Claims Operations staff by automating routine tasks within and around their health care benefit administration system.  Kwik Actions are custom developed “hotkeys” that users may utilize on demand to perform a predetermined set of screen navigation steps (keystrokes, mouse clicks, screen navigation and database queries) within a few seconds.

Examples of Configured Kwik Actions:
Display a scanned claim image
Display a scanned authorization image
Display a UM Referral Slip report and invoke fax page and faxing out through a server
Eligibility:
Eligibility: Authorization search
Eligibility: Claims search
Eligibility: Note entry
Eligibility: Primary care physician search
Eligibility research on Health Plan site and capture Webpage image

Kwik Actions can even automate processes across multiple applications.

For example:
The Display Scanned Claim/Auth Image Kwik Actions can display a scanned image in the benefit administration software and retrieve images in a separate imaging system.
Note: an added benefit is that the solution cuts down on the cost of seat licenses for 3rd party imaging software.

These are only a few of the processes that can be performed with Kwik Actions, but the possibilities are endless, as any set of repetitive manual steps in a software application is a candidate for Kwik Actions.

For more information on SymKey Kwik Actions, click here.

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Posted in Business Process Automation, Corporate Blog, Did You Know?, HCIM's Solutions, Information Technology, SymKey, Tips & Tricks | No Comments »

Reduce Operational Costs to Alleviate the Burden of Economy & Health Care Reform

Tuesday, October 5th, 2010

Continuing economic pressures and recently enacted Health Care Reform mandates place additional pressure on all health plans and managed care/payers to improve their operational efficiencies and reduce associated costs. Future reductions in Medicare reimbursement rates and increased competition will also require everyone to “do more with less money.”  Industry mandated changes for HIPAA X12 5010 transactions and ICD-10 Diagnosis codes will also add to these efficiency pressures and stretch current limited project staff resources even more.

The new ICD-10 code changes will have a direct and significant financial business impact on revenues on health plans, payer organizations and health care providers. The ICD-10 code set change is not just another new IT project. The ICD-10 changes are much more than simple cross references from the old ICD-9 codes to the new ICD-10 codes. In fact, these types of simple cross walks will simply not work. For many of the new ICD-10 codes, there is a “one to many” code range from the old codes to the new codes. There will also be a significant internal staff retraining effort required with this new code set. This will not be accomplished by simply providing all staff members with a simple cross reference list. For example, some of the areas that will be directly impacted are: provider contracts, benefits plans, performance related reporting (both internal and external), and all related risk severity adjustments to name a few.

Now is the time to start educating and preparing each organization’s key stake holders on the specific changes required in implementing the new ICD-10 code sets, the required resources to implement them, and the required budget allocations to effectively accomplish the new mandated changes. ICD-10 codes must be implemented in the next couple of years. They are not going away!

Every week, we hear from current and prospective clients who are looking for new software technologies and services solutions that will provide the needed efficiency improvements and cost reductions that are so critically needed and sought after. Several of HCIM’s solutions do in fact already provide these types of efficiency gains and immediate Return on Investment (ROI). Many of these related client testimonials are provided in HCIM’s website, newsletters, and solutions fact sheets. I would encourage those who are seeking these types of immediate result-orientated solutions to browse our website and associated content. Several of our clients are already achieving these critical improvements and cost reductions.

In my upcoming blog postings, I will talk more about our expanding efforts to provide educational and training opportunities related to the new ICD-10 code sets. Stay tuned for more information.

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Posted in Business Process Automation, Corporate Blog, Did You Know?, HCIM's Solutions, Industry Blog, SymKey | No Comments »

FAQ: The 2010 CMS Fee Schedule was released and is effective retroactively. We have already paid claims for the last several months that now need to be repriced. Can SymKey automatically reprice them?

Friday, September 24th, 2010

Yes, SymKey’s “Reprocess/Pend” standard scenario is a perfect automated solution for repricing paid claims and is very simple to use for EZ-CAP status 9 claims.

  1. Create a .txt file with a list of the paid claim numbers that need to be repriced
  2. Open the SymKey Professional Claims module
  3. Check the “Reprocess/Pend” checkbox about ¾ the way down on the left side
    Note: most of the screen will be grayed out and Source Claim Status 9 will automatically be selected.
  4. In the “Global Options” section at the top of the Professional Claims module:
    – Check the “Reprice Claim Lines” checkbox
    – Check the “Adjustment Code” checkbox
    – Select an adjustment reason from the drop-down list
    – Check the “Adjust All Lines” checkbox
  5. Click the “Process Batch” button

SymKey will automatically perform the following:

  1. Create a set of new claims in EZ-CAP status 3
  2. Duplicate the demographic and line detail for each claim in the input file
  3. Reprice each line to the new fee schedule
  4. Subtract the original payment from the amount due, resulting in a net pay of the difference in fee schedule amounts

Example:
The original claim paid $45.50 for a particular claim line.
Under the new retroactive fee schedule, the payment should have been $48.90.
Using the “Reprocess/Pend” scenario, SymKey will create a new claim with:
Claim Line Contract Value: $48.90
Negative Adjustment: $45.50, with the Adjustment Reason Code specified by the user
Claim Line Net Pay: $3.40

If you’re interested in more of the automatic benefits administration solutions that HCIM has to offer, call 888-454-0202, option 5 or e-mail us at sales@hcim.com.

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Don’t miss out on Business Process Automation Opportunities

Wednesday, June 2nd, 2010

I recently visited one of our current SymKey® for EZ-CAP® clients in the Midwest. We met with our client’s COO for a couple of hours on a Monday morning. She shared with us the exciting activities and long term strategies that their organization has been working on in their efforts of continuous improvement and striving to bring ongoing “value-add” to the physician groups that they manage. As one of their strategic partners, she asked us to work with her operations staff to identify new business process automation opportunities to increase their claims auto-adjudication and the use of our SymKey for EZ-CAP product that they have been licensing for the last 18 months. She just knew that additional opportunities existed. I told her that we are always available and willing to work with our clients on these operational efficiency improvements efforts. We will be scheduling an onsite trip to work with this client in the next one to two months. When our customers further leverage their utilization of SymKey, their return on investment is increased and operational gains are achieved, which results in real bottom line gains.

I like to refer to these efforts as “peeling back the layers of an onion.” Just as someone peels back each layer of an onion to find a new fresh layer, so must operational managers and staff continuously review and identify current manual business processes that can be automated. Historical decisions as to why certain manual processes were established must be revisited and  re-analyzed on a regular basis (every six to 12 months). The justification for the manual process must be questioned and new opportunities must be explored to automate current processes with the use of tools such as SymKey. In today’s health plan/payer operations, there are generally several layers of operational processes and pending of claims that can be reviewed and analyzed on a regular basis to identify the manual processes performed by staff that are either outdated or that can be automated.

HCIM’s support staff and operational consultants are always willing and available to work with our current and prospective clients to identify new opportunities to further utilize SymKey’s automation and consistent processing of claims and authorizations. I am looking forward to going onsite and working with this specific client as a strategic partner to assist them in peeling back new layers of the onion and further increasing the automated-adjudication of claims with SymKey for EZ-CAP!

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Posted in Business Process Automation, Consulting Services, Corporate Blog, Did You Know?, HCIM's Solutions, Industry Blog, SymKey | No Comments »

Can BPA help you ditch the Sticky Notes?

Thursday, May 20th, 2010

During my time spent as an Operations Manager, I remember that my claims processors had sticky notes all over their monitors and cheat sheets that they would use to remind them of manual or special processes for certain providers or members. Not everyone had the same sticky notes, nor did they all have the same handwritten notes on their cheat sheets. This was always an impediment to providing consistent service and claims adjudication results. No matter how hard they tried to remember everything, there was just too much to remember for all the claims they encountered on any given day. As Operations management staff, we were always on the lookout for tools that would allow us to automate our business processes. 

When I first saw the rudimentary running of the precursor to SymKey®, I knew that it could lead to the Business Process Automation (BPA) tool that I had been looking for and desperately needed. I immediately envisioned what has since become SymKey, a tool that has been in use by over 20+ clients in the past five years. HCIM has worked to expand our BPA vision to our other software solutions and services (ScanClaims™, Appeals Manager™, and other HCIM custom software applications) that are in current use by our clients throughout the managed care/payer industry, and on multiple platforms.

HCIM’s BPA solutions and services are cost-effective, user friendly, easy to implement, and provide both real productivity gains and a tangible return on investment. I invite others with my similar operation experiences to check out HCIM’s BPA solutions and services. You too can have the tools to eliminate the sticky notes and handwritten cheat sheets in your office.

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Tips & Tricks: Using SymKey Batch Processing with an external pricing source to set the contract value of claim lines

Thursday, April 29th, 2010

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.

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Posted in Business Process Automation, Corporate Blog, Did You Know?, HCIM's Solutions, Industry Blog, SymKey, Tips & Tricks | No Comments »

Industry Trend to Reduce Operating Costs and Gain Operational Efficiencies

Monday, March 22nd, 2010

During the first part of this new year, we have experienced increased inquiries and requests for product demos of our SymKey® product solution. In fact, we licensed one new SymKey® for EZ-CAP® client last month and are currently working on licensing arrangements with two prospective new clients. I believe this increased interest is due to SymKey’s ability to deliver immediate results and significant bottom line Return On Investment (ROI) in automating manual claims processing and auto-adjudication of claims within the many managed care/health care payer core transaction systems that SymKey integrates with. There are increased demands to reduce operating costs and gain operational efficiencies while experiencing reductions in membership and/or reduced premium revenues in many segments of today’s managed care/health plan payor market. HCIM’s SymKey product and other product solutions deliver on these expectations for our clients.

Some of our new SymKey clients have made the decision to bypass our 30-day risk-free SymKey trial period and go straight to licensing it, saying the decision was a “no brainer” for them. They saw the immediate results that SymKey is able to provide and didn’t want to waste time achieving these efficiencies and cost savings.

We look forward to working with our new SymKey clients on improving their company’s performance and bottom line results in 2010. I encourage all interested parties to review the content in our Products and Services web pages and to contact HCIM at 888-454-0202 or sales@hcim.com to further pursue the immediate cost saving and ROI results provided by all of HCIM’s product and services solutions.

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Posted in Business Process Automation, Consulting Services, Corporate Blog, Did You Know?, HCIM's Solutions, Industry Blog, Industry News, SymKey | No Comments »

Tips & Tricks: Updating Claim Specific Data with Batch Processing

Friday, February 26th, 2010

The standard scenarios in the Professional and Hospital Claims modules are perfect for repeating the same action and values again and again over a large number of claims. For example, if you have 500 claims with Provider ABC and need to change them to Provider XYZ, this can be done very simply and very quickly. But what if you also need to apply unique Provider IDs to each of the claims? It would take 500 batches to make this change in the standard module, but SymKey’s Batch Processing module can apply a unique provider ID to each of the 500 claims in a single batch!

Reporting tools such as Crystal Reports or even a simple spreadsheet containing the changes you need can be used to create the input file that the Batch Processing module will use to perform this complex action. If you have questions about how Batch Processing can do more for your company, please contact us at support@hcim.com or 888-454-0202.

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Posted in Business Process Automation, Corporate Blog, Did You Know?, HCIM's Solutions, Industry Blog, SymKey, Tips & Tricks | No Comments »