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 firstname.lastname@example.org or 888-454-0202, ext. 126.