Posts Tagged ‘SymKey’

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.

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.

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.

FAQ: I see the Batch Processing module is included in my license. Where do we start?

Thursday, August 26th, 2010

Answer: In SymKey for EZ-CAP v. 1.30 and higher, click the “Documentation” link in the “Help” section on the left side of the SymKey main menu. Select the “Batch Processing Technical Procedure Guide” from the “Documentation” sub menu. The guide provides a detailed overview of the available functionality as well as instructions on how to build and use a Batch Processing input file.

As always, HCIM is here to help however we can. If you have any questions, contact HCIM Product Support at support@hcim.com or 888-454-0202, option 2.

FAQ: We only have a handful of claims to run in a special batch. How can we create a source file?

Thursday, August 12th, 2010

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.

FAQ: How can we expand our use of SymKey to handle more claims?

Wednesday, July 28th, 2010

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.

FAQ: Can SymKey perform multiple scenarios during the same batch?

Thursday, July 15th, 2010

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.

SymKey Has Achieved Revenue Growth of 333% over the Past Five Years

Wednesday, July 14th, 2010

As the economy struggles to recover, we are seeing our SymKey® solution sales soar due to an ever-increasing need for health plans/managed care payer organizations to reduce costs, increase efficiency, improve consistency, and minimize errors through business process automation. This year, we are projecting a 36.5% revenue growth in SymKey sales over last year alone, and a 333% increase over fiscal year 2005. That’s an impressive 333% revenue growth in only five years!

Contributing to our remarkable SymKey revenue growth is both the amount of new multi-year SymKey licenses that are signed every year and our high client retention rate. Prospective clients like to “test drive” SymKey with our 30-day risk-free trial, which affords them the opportunity to assess SymKey’s immediate Return on Investment (ROI) without a long term licensing and expense commitment. Since our product solutions are professionally implemented by our experienced Product Integration Team and maintained by our Product Support experts, our clients achieve a rapid, successful implementation and continue to enjoy the peace of mind they deserve.

 Here’s what a couple of our clients have to say:

“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 for three months 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,” said Linda Deaktor, Director of Medical Affairs at MedPOINT Management. MedPOINT has been a SymKey client since February 2010 and has licensed the SymKey® for EZ-CAP® Professional and Hospital Claims modules, as well as the Virtual Auto-Post™ module.

“I’m watching a SymKey® scenario right now. It just keyed the equivalent of 1,151 claims per hour. Most full time claims analysts process around 200 claims a day. My staff would be superhuman if they could key half as fast as SymKey! My analysts love us using SymKey because it boosts production, reduces errors, and saves them from having to do a lot of tedious manual work,” said Tammy Anderson, Claims Manager at Managed Care Systems, L.P. (MCS). MCS has been a SymKey client since August 2004 and has licensed the following HCIM products: SymKey® for EZ-CAP®, SymKey® for QNXT™, ScanClaims™ Auth Manager, ScanClaims™ Claims Manager, ScanClaims™ DCI, and Appeals Manager™ v. AB1455.

SymKey® is an advanced automated claims and authorizations adjudication system that wraps around clients’ managed care core transaction systems such as EZ-CAP®, Facets®, QNXT™, and Amisys Client Server. Read More >>

FAQ: Can SymKey move claims within EZ-CAP to a status beyond 3?

Thursday, July 8th, 2010

Answer: SymKey for EZ-CAP is designed to work within EZ-CAP’s Professional and Hospital claims modules. As a result, it is able to automate the moving of claims that are in status 1-7 to a status 1 or 3. It can also reprocess status 9 claims by creating a new claim number, entering all related detail line information, and placing them in a status 3. Moving a claim to a status 5 or beyond, however, requires the use of EZ-CAP’s Payment Processing module. Although SymKey is not designed for the EZ-CAP Payment Processing module, HCIM developed the SymKey for EZ-CAP Move 1 to 5 Kwik Utility, which automates the moving of a list of claim numbers from a status 1 to a status 5.

If you do not already have the SymKey Move 1 to 5 Kwik Utility and would like more information, please contact HCIM Product Support at support@hcim.com or 888-454-0202, option 2.

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.