Tips & Tricks: Copy and Reverse

Did you know that SymKey® can accurately copy and/or reverse a claim, with or without repricing the contract values in the claim detail lines?

Create Exact Claim Copy Functionality

Use this action to split claims with a DOS that spans a benefit or contract renewal date, or to divide financial responsibility.

With the Exact Claim Copy action, SymKey® creates an “exact” copy of another claim. You can combine this function with other actions via the Query module, including repricing the newly copied claim, recalculating the allowed amounts, applying a new adjustment reason code, and reprocessing the claim.

Items that will automatically be copied:   Optional items to copy:
  • Header and detail lines
  • Adjustment reason codes
  • All amounts
 
  • Memos
  • Processing Statuses
  • Notes

Reverse Functionality

Use this action to correct payments to incorrect providers or members.

With the Reverse action, SymKey® negates the quantity of each claim line (Billed Charge and Contract Value) and reverses benefit accumulators. It can also reverse all other amounts on the line (positive amounts become negative and negative amounts become positive), resulting in a reversed (negative) net pay. SymKey® can either reverse all lines or specified lines on the claims, with some restrictions. You can also combine this function with other actions via the Query module.

SymKey® can reverse claims in any status. In order to reverse previously paid claims, simply combine the Reverse action with the Create Exact Claim Copy action (above). An additional optional action is that if the claim line reprice action is set to not reprice, SymKey® will ignore the claim system’s automatic re-price after Quantity is made negative, and will enter the original Contract Value, Deductible, and Copay amounts as negative values.

Learn More

To learn how to automate these scenarios with SymKey®, contact Laurie Kirkland at lkirkland@hcim.com. Existing SymKey® users can email support@hcim.com for more information.

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.