Client Spotlight: Network Medical Management

Network Medical Management uses SymKey to Process over 700 claims per hour

Network Medical Management (NMM), an MSO overseeing eight IPAs in seven Southern California counties, licensed SymKey 3.0 for EZ-CAP in June 2013. They have been using SymKey to automate their claims processing at speeds averaging over 700 claims per hour. During their 30-day trial, SymKey processed 15,000 claims in 24 hours!

“During NMM’s 30-day trial, we worked together to develop dozens of automated workflow queries for SymKey to run, including a 23-query sequence to process a variety of claims scenarios on a daily basis. SymKey processed 125,000 claims during the trial period and ran nonstop for over 24 hours on multiple occasions,” said Tom Streeter, SVP, Product Solutions at HCIM.

Best New Feature: Set it and forget it!

SymKey 3.0’s new Query Builder and Scheduler allow users to queue up automated workflows and schedule them for any time, day or night. These new features have greatly increased claims processing efficiency.

“I run 80% of my claims through SymKey and the new Batch Manager is heaven sent. I just schedule all my reports and SymKey does its thing, so I don’t even have to look at it,” said Kathleen Leaño, Director of Operations at NMM.

Favorite Scenario: Authorization Matching

Kathleen’s favorite scenario involves authorization matching. SymKey 3.0 can identify the corresponding Auth IDs for their professional claims, automatically populate the authorization, and then reprice all claim lines. HCIM and NMM worked together to develop 17 additional authorization matching queries that populate the correct Auth ID, but with variations in criteria and final outcome of the claim, such as completing, denying, or pending the claim.

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.