During a year of rapid growth, Northwest Physicians Network (NPN) doubled the size of their Provider network and drastically increased their membership. With plans to take on one or two more health plans next year, they decided to get ahead of the additional workload by licensing SymKey® to increase their claims auto-adjudication rate through robotic automation.
“We decided that 2016 would be the year of efficiencies,” said Joanne Doss, Claims Delegation Program Manager at NPN. “I’d estimate that before SymKey®, somewhere around 95% of our claims were manually touched in some way. So we decided to let SymKey® handle the mundane work, which would allow our processors to focus on analyzing and adjudicating the more complex claims.”
“We had an idea of what SymKey® could do from talking to other users, so we went into it pretty prepared,” said Doss. “We had meetings with the processors and asked what they did manually, then we built a spreadsheet of the manual processes to automate. We keep adding to that list as we go.”
NPN is currently on EZ-CAP® 6.x and has been experiencing average SymKey® processing speeds of 235 Professional Claims per hour and 125 Hospital Claims per hour. They schedule SymKey® to run every evening so it processes the claims before the claims examiners come in each morning.
Favorite SymKey® Scenario
“So far my favorite scenario has been addressing the bundled non-covered codes, which was nothing but adding an adjustment code and was such a waste of time for an adjudicator. SymKey® has really helped to eliminate that manual process,” said Tammie Wood, Claims Systems Analyst at NPN.
“All the individuals we’ve worked with at HCIM have been stellar. They’re just good people, which is rare,” said Doss.
“Preparation is key,” said Doss. “Meet with your team prior to the implementation and have a conversation about what they do manually so you can build your wish list. It’s hard for claims processors to think about these mundane manual processes off the top of their heads, so they should take notes throughout their day to add more scenarios to the list.”
“It was a delight to work with Joanne and Tammie at NPN,” said Thomas Streeter, Senior VP, Product Solutions. “I was extremely pleased at how organized and prepared they were with documented scenarios, ready to discuss what they wanted SymKey® to do. That made the time on-site extremely productive.”