Client Spotlight: PrimaryHealth of Josephine County

Following a successful 30-day trial period, PrimaryHealth of Josephine County (PHJC), formerly Oregon Health Management Services, licensed SymKey 2.0 for EZ-CAP 6.x on Oct. 20, 2012.

“We decided to begin a free 30-day SymKey trial to see if it could speed up our adjudication process by auto-adjudicating more claims. When Greg and Tom came on site to install SymKey and train our team, we were impressed by their depth of understanding of the EZ-CAP system, claims processing, and adjudication. After Greg wrote a number of reports for us, it became clear that our company would benefit from SymKey,” said Maggie Rollins, Director of Operations at PHJC.

During the three-day onsite installation and training period, HCIM’s Product Solutions Team met with PHJC’s claims operations staff to review their claims workflows and develop numerous innovative reports to automate their Professional and Hospital claims adjudication process. SymKey was able to automate the following commonly-encountered scenarios for PHJC:

  • Deny all claims for providers that are not approved by Medicaid (as indicated by a B7 prefix that EZ-CAP adds to their last name).
  • Identify and deny claims with a diagnosis code that is excluded from Oregon Medicaid.
  • Identify claims where the net pay is greater than the billed amount for that line (due to either contract value or copay) and adjust the net pay to equal the billed charges.
  • Calculate the proper contract value for ambulance claims based on the miles traveled by removing the first 10 miles from the contract value as calculated by EZ-CAP (because the first 10 miles are included in the base rate).
  • Search the claim note field to identify the APC contract value that is imported via EDI and move this amount to the line’s contract value.

“SymKey has reduced the hands-on repetitive keying, thus allowing our adjudicators to do what they do best, adjudicate claims! We saw an immediate savings of at least 10 hours per week, which means that our valuable staff is able to allot their time to more in depth projects. As we continue to develop reports for SymKey to run, we’re able to realize even more time savings by shifting work instead of hiring new staff,” said Rollins.

In the two months since they licensed SymKey, PHJC has reported continuing success and is continuing to look for new ways to automate claims processing with SymKey.

“It was great working with Maggie and Aleesa because they were enthusiastic about SymKey from the beginning and immediately understood how it would be of value to their organization. This value was confirmed during their SymKey trial through the realization of significant staff time savings,” said Tom Streeter, HCIM’s Senior Vice President, Product Solutions.

HCIM stands behind its products because a vendor’s success is largely measured by the success of its clients. This dedication to customer satisfaction drives the symbiotic client-vendor relationship that HCIM strives to foster.

“Everyone has been wonderful to work with! Not only was our onsite visit great, but continuing support is timely, responses to our questions are well thought out, and it’s clear that HCIM has our best interest in mind!” said Rollins.

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.