Client Spotlight on Foundation for Medical Care of Tulare & Kings Counties

In November 2014, Foundation for Medical Care of Tulare & Kings Counties (The Foundation) upgraded their claims management software and experienced a 75% drop in claims productivity. Their turnaround time went from 5-7 days to over 40 days within two months. At the prompting of HCIM, they began a 30-day SymKey® for EZ-CAP® trial in hopes of solving their productivity dilemma.

“We decided to purchase SymKey® two weeks into the trial. Had we not found SymKey®, we would have fallen even further behind with no end in sight,” said Brandi Guinn, Administrator of Managed Care at The Foundation.

One of The Foundation’s favorite automated workflows involves processing Physical Therapy (PT) claims. They pay a per diem for PT, so SymKey® was programmed to review the dates of service, pay one line, and adjust the others. They can also pay an evaluation on the same day as a therapy without a copayment, but take a copayment on the other line with the same date of service. The PT claims used to be very time consuming to process, but now they can simply switch on the SymKey® query and let it run.

Using SymKey®, The Foundation estimates a savings of 1-3 FTEs per year. “It’s time consuming to train new staff, but with SymKey® we have no loss of production when we increase our membership or when staff is out of the office,” said Brandi. “We didn’t have the IT staff to develop the SymKey® processes so we contracted with HCIM to support our query building. I worked with their programming staff remotely on queries using GoToMeeting and it was extremely helpful. HCIM’s team has been amazing.”

“The Foundation’s on-site SymKey® implementation and training went extremely well, largely due to Brandi Guinn and staff’s preparation and engagement throughout the trial. It enabled our development staff to program over 70 SymKey® queries for professional and hospital claims (3-4x more than usual) during that period,” said Thomas Streeter, HCIM Senior Vice President, Product Solutions. “This allows The Foundation to utilize SymKey® to automate more of their manual workflows, resulting in greater productivity and time savings.”

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.