Reprocessing Previously Paid Historical Claims can be a Piece of Cake!

Oftentimes claims staff put off the dreaded task of manually reprocessing previously paid claims because it can be difficult and time-consuming. Do you ever run into any of the following problems?

  • CMS makes corrections to the Medicare Physician Fee Schedule (MPFS) and you must retroactively reprocess Medicare fee-for-service claims
  • Members are identified as retroactively termed after the claims were already paid so those claims need to be reprocessed
  • Claims that were paid to the incorrect/ineligible provider or vendor need to be reprocessed
  • An individual claim line needs to be added, removed, or adjusted on a claim
  • Need to reprice a claim or claim line
  • Need to reverse and adjust a copayment
  • Need to calculate an over/underpayment
  • Need to reprocess claims processed through a third party repricer (APC/DRG)

If you use either the EZ-CAP® or Plexis Claims Manager™ (PCM) core claims systems, you can utilize HCIM’s SymKey® robotic automation software to make these changes as easy as pie…or cake. For more information, click here or contact Laurie Kirkland at or 888-454-0202, ext. 126.

If you’re a current SymKey® client, learn how to reprocess your claims:
Tips & Tricks: Copy and Reverse
SymKey Reprocess/Pend Scenario

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.