Yes, SymKey’s “Reprocess/Pend” standard scenario is a perfect automated solution for repricing paid claims and is very simple to use for EZ-CAP status 9 claims.
- Create a .txt file with a list of the paid claim numbers that need to be repriced
- Open the SymKey Professional Claims module
- Check the “Reprocess/Pend” checkbox about ¾ the way down on the left side
Note: most of the screen will be grayed out and Source Claim Status 9 will automatically be selected.
- In the “Global Options” section at the top of the Professional Claims module:
– Check the “Reprice Claim Lines” checkbox
– Check the “Adjustment Code” checkbox
– Select an adjustment reason from the drop-down list
– Check the “Adjust All Lines” checkbox
- Click the “Process Batch” button
SymKey will automatically perform the following:
- Create a set of new claims in EZ-CAP status 3
- Duplicate the demographic and line detail for each claim in the input file
- Reprice each line to the new fee schedule
- Subtract the original payment from the amount due, resulting in a net pay of the difference in fee schedule amounts
The original claim paid $45.50 for a particular claim line.
Under the new retroactive fee schedule, the payment should have been $48.90.
Using the “Reprocess/Pend” scenario, SymKey will create a new claim with:
Claim Line Contract Value: $48.90
Negative Adjustment: $45.50, with the Adjustment Reason Code specified by the user
Claim Line Net Pay: $3.40
If you’re interested in more of the automatic benefits administration solutions that HCIM has to offer, call 888-454-0202, option 5 or e-mail us at firstname.lastname@example.org.