Addressing the Need for Business Process Automation in Healthcare Claims

Those who don’t analyze and improve on the mistakes of the past are doomed to repeat them. This is evidenced by the healthcare industry still being one of the very few industries that, despite the influx of technology available today, is still primarily a paper based industry, requiring some organizations to keep on hand large staffing volumes in order to process their paper claims. Some of these organizations are turning to business process automation (BPA) to help them keep up with their ever increasing workload.

BPA is a strategy to contain or lower costs, which generally consists of application integration, reassigning labor resources and the use of software applications throughout the organization. In order to perform successful BPA, an organization should define its business processes as part of an overall strategy for improving the efficiency of the business. There are many techniques for automating a business process, such as developing in-house automation software or purchasing a BPA tool.

Some organizations choose to expand the functionality of their core administrative processing system to create the desired automation, enabling customized linkages between multiple application systems where needed. This approach means the automation can be tailored specifically to the environment of the organization; however, most internal IT departments are overburdened and do not have the time it takes to develop and maintain such a solution. Internal or external resources with the skill and knowledge of specific healthcare industry business processes can be hard to find.

An alternative would be to purchase a BPA tool. There are a variety of software companies and consulting organizations that have brought BPA tools to market which leverage the user interface layer rather than going into the application code or the databases sitting behind them so that these tools can be used by the owners of the organization’s business processes. These toolsets can usually be deployed quickly and because they focus on the user interface layer instead of trying to perform automation through the backend of the organization’s core administrative processing system, they avoid potential support and warranty issues with that system’s vendor. Some of these BPA companies are even trained and certified by the administrative system vendors and are experts in healthcare operations.

While common healthcare payer core administrative processing systems have attempted to create systems that are flexible enough to help payer organizations meet their day to day business needs, the complexity of the industry still leaves areas where the flexibility and configurability of these systems are challenged, leaving opportunities for payer organizations to examine their business processes for areas of improved efficiency. If resource-strapped organizations are unable to devote the time necessary to improve their business processes, they may seek to purchase a BPA tool such as SymKey® by HealthCare Information Management, Inc. (HCIM). Since 2000, HCIM has delivered technology solutions and consulting services to health care payers and managed care organizations. HCIM’s flagship SymKey® solution is a powerful automation tool that performs a predefined series of actions on hundreds of claims at a time within a client’s existing administrative processing system, seamlessly automating claims processing at speeds 6-8x faster than manual processing. SymKey® operates directly through the claims system’s user interface just like any user would, but much faster, and can be managed through a user-friendly interface.

If your organization’s strategy is to use business process automation to contain or lower costs by improving operational efficiency, then it should consider SymKey®. The automated SymKey® solution is both easy to configure and fast to deploy. Organizations that have adopted it process their claims faster and more accurately, meeting the demands of today’s tight timelines and budgets. They also see considerable improvements in productivity within their core claims processing system, including systems such as TriZetto’s Facets and QNXT, Citra’s EZ-CAP®, Plexis Healthcare Systems’ Plexis Claim Manager and Monument Systems’ Monument xpress . To find out more about SymKey®, visit www.hcim.com/products/symkey.

Brian James, Director of Technical Services

Brian James

Director, Technical Services

About HCIM

Since 2000, HealthCare Information Management, Inc. (HCIM) has delivered expert consulting services and robotic automation tools for small to mid-sized healthcare payer and managed care organizations. Our concierge consulting services include everything from core claims system procurement to go live, including configuration, migration, upgrades, reporting, benefits and fee schedules, user training, and project resourcing. We also offer strategic consulting in the areas of value based payments, population health, medical management, medical loss analysis and recovery, care management, provider contract modeling, data analytics, and business process reengineering/analysis.