HCIM

Answer: To easily create a standard scenario processing batch file, all you need is a column of claim numbers in a text file:

1. In either Windows Notepad or an Excel spreadsheet, simply enter the column of claim numbers and save the file:
   File Type: *.txt
   Destination: SymKey\Files\Source directory
2. Browse for the file as usual within the SymKey Professional or Hospital Claims module.

Answer: This is a four-step process:

1. Identify the type of claims that you would like to target (i.e. denying claims that exceed a timely filing threshold).
2. Define what claims fall into this scenario (i.e. timely filing claims may be in-network providers as defined by the “ZZZ” in the Provider Contract field, where the date received is more than 180 days after the DOS).
3. Create a report of claims for input into a SymKey scenario or Batch Processing.
4. Test the report and scenario configuration in SymKey.

At any step along the way, HCIM’s expert Product Support team is available to field questions, offer advice, or work with you to complete the entire process. Contact HCIM Product Support at support@hcim.com or 888-454-0202, option 2.

Answer: Yes, SymKey can perform certain scenarios in combination with others, combining multiple single-action batches into one complex batch. When a scenario is selected in the Professional or Hospital Claims module, other scenarios may become disabled, indicating that the disabled scenario actions cannot be combined with the selected scenario action. The scenarios that are still selectable can be performed along with the scenario action that was initially selected. Simply select the actions to be performed and SymKey will process them in the correct order once the “Process Batch” button is clicked. In SymKey v. 1.31 and above, you can verify the scenario action processing order prior to running the batch by clicking the “Scenario Summary” button – a summary of the actions that SymKey is configured to perform and the order that SymKey will perform them in will be displayed.

In addition to SymKey’s standard scenarios in the Professional and Hospital Claims modules, the Batch Processing module allows users to configure their own batches with more control and flexibility.

If you have questions about setting up multiple scenarios or utilizing batch processing for your business needs, please contact HCIM Product Support at support@hcim.com or 888-454-0202, option 2.

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.

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.

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.

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.