HCIM’s SymKey® for EZ-CAP® application is specifically designed to automate the processing of claims within the EZ-CAP® claims transaction system. Using programmed artificial intelligence and innovative keystroke emulation technology, SymKey can help claims staff to process claims up to 40 times faster. Some of HCIM’s SymKey clients have been able to process over 1,000 claims per hour, in comparison to the 25 claims per hour that a typical claims processor can manually key.
SymKey for EZ-CAP was first licensed in 2004 and is currently in use at 19 client sites. HCIM compiled productivity statistics from 17 SymKey for EZ-CAP clients. The reported clients listed below achieved an ROI of approximately $6 million in 2011 by processing over 7.2 million claims at an average of 447 claims per hour and completing the equivalent workload of 152 full time claims processing staff.
| Membership Tier 1 | ||||||||
| Client | Lives | Claims Touched |
Completed/ Denied |
Complete Rate |
Total Hours |
Claims/ Hour |
Staff Equiv. |
Salary Equiv. |
|---|---|---|---|---|---|---|---|---|
| A | 15,000 | 19,600 | 12,237 | 62% | 244 | 80 | 1.2 | $48,595 |
| B | 23,000 | 74,434 | 72,153 | 97% | 1,050 | 71 | 2.1 | $82,021 |
| C | 24,000 | 184,801 | 154,936 | 84% | 64 | 2,880 | 3.8 | $152,728 |
| D | 24,000 | 14,783 | 12,112 | 82% | 62 | 240 | 0.3 | $12,217 |
| Avg. | 21,500 | 73,405 | 62,860 | 86% | 355 | 207 | 1.8 | $73,890 |
| Membership Tier 2 | ||||||||
| Client | Lives | Claims Touched |
Completed/ Denied |
Complete Rate |
Total Hours |
Claims/ Hour |
Staff Equiv. |
Salary Equiv. |
|---|---|---|---|---|---|---|---|---|
| E | 36,500 | 38,521 | 19,311 | 50% | 361 | 107 | 1.0 | $38,203 |
| F | 40,000 | 366,908 | 140,723 | 38% | 476 | 772 | 7.6 | $303,230 |
| G | 50,000 | 251,367 | 210,634 | 84% | 396 | 635 | 5.2 | $207,741 |
| Avg. | 63,250 | 328,398 | 185,334 | 56% | 616 | 533 | 6.9 | $274,587 |
| Membership Tier 3 | ||||||||
| Client | Lives | Claims Touched |
Completed/ Denied |
Complete Rate |
Total Hours |
Claims/ Hour |
Staff Equiv. |
Salary Equiv. |
|---|---|---|---|---|---|---|---|---|
| H | 57,000 | 3,301 | 926 | 28% | 35 | 94 | 0.3 | $10,912 |
| I | 63,000 | 423,237 | 342,791 | 81% | 429 | 987 | 8.7 | $349,783 |
| J | 65,000 | 2,821,940 | 2,292,408 | 81% | 2,590 | 1,090 | 58.3 | $2,332,182 |
| K | 75,000 | 344,523 | 262,508 | 76% | 538 | 640 | 7.1 | $284,730 |
| L | 75,000 | 164,726 | 115,817 | 70% | 2,022 | 81 | 4.5 | $181,516 |
| M | 76,000 | 57,930 | 39,236 | 68% | 44 | 1,330 | 1.2 | $47,876 |
| Avg. | 68,500 | 635,943 | 508,948 | 80% | 943 | 674 | 13.4 | $534,500 |
| Membership Tier 4 | ||||||||
| Client | Lives | Claims Touched |
Completed/ Denied |
Complete Rate |
Total Hours |
Claims/ Hour |
Staff Equiv. |
Salary Equiv. |
|---|---|---|---|---|---|---|---|---|
| N | 106,000 | 600,801 | 281,239 | 47% | 4,043 | 149 | 12.4 | $496,530 |
| O | 130,000 | 1,364,575 | 961,851 | 70% | 2,050 | 666 | 28.2 | $1,127,748 |
| P | 139,000 | 113,423 | 42,243 | 37% | 1,328 | 85 | 2.3 | $93,738 |
| Q | 456,000 | 356,314 | 301,967 | 85% | 378 | 942 | 7.4 | $294,474 |
| Avg. | 207,750 | 608,778 | 396,825 | 65% | 1,950 | 312 | 13 | $503,123 |
| Totals | ||||||||
| Lives | Claims Touched |
Completed/ Denied |
Complete Rate |
Total Hours |
Claims/ Hour |
Staff Equiv. |
Salary Equiv. |
|
|---|---|---|---|---|---|---|---|---|
| Overall Avg. | 90,906 | 450,074 | 328,943 | 73% | 1,007 | 447 | 9 | $379,014 |
| EZ-CAP 5.x Avg. | 99,962 | 535,286 | 390,323 | 73% | 1,000 | 535 | 11 | $445,367 |
| Overall Totals | 1,454,500 | 7,201,184 | 5,263,092 | 73% | 16,109 | 447 | 152 | $6,064,224 |
Analysis of Results
- The client productivity statistics were broken down into separate tiers based on membership in order to provide a weighted average that can be used to model ROI for prospective clients with similar membership levels.
- The “Totals” table illustrates a straight “Overall Average” across all reporting SymKey clients, an “EZ-CAP 5.x Average” across all reporting SymKey for EZ-CAP 5.x clients, and “Overall Totals” for all reporting SymKey clients.
- Client A was a new SymKey client and only used SymKey for 4 months in 2011, but they realized an immediate ROI in that time. Their Claims Manager said, “SymKey’s price tag was unbelievable! I didn’t think a small company like ours would be able to afford it, but the cost was so reasonable and the ROI was just amazing. I’m seeing a 3x return on my investment!” Their Processing Staff Equivalent and Salary Equivalent were annualized.
- Client B hours adjusted to account for estimated system downtime.
- Client C has a membership of 24,000 lives and processed 184,801 claims at a rate of 2,880 claims/hour with an 84% completion rate. Their outstanding statistics were achieved with technology upgrades including state-of-the-art servers running SQL Server 2008, as well as optimized table efficiency through the use of indexes. This client is on EZ-CAP v. 5.3x.
- Client E was a new SymKey client and only used SymKey for 10 months in 2011. Their Processing Staff Equivalent and Salary Equivalent were annualized.
- Client H was a new SymKey client and only used SymKey for 4 months in 2011. They licensed the SymKey® Virtual Auto-Post™ module and had not licensed either of the claims modules, which is why their usage was low compared to the other clients. Their Processing Staff Equivalent and Salary Equivalent were annualized.
- Client J processed 2,821,940 claims at 1,090 claims/hour for the equivalent of 58.3 FTEs for a net savings of over $2 million. They have a Medicare membership base and run 100% of their claims through SymKey to post CCI edit recommendations. Many of their claims are processed two or three times by SymKey to perform multiple scenarios.
- Client O was impacted by a retroactive fee schedule change that involved processing over 300,000 claims on top of their current workload. A project of this magnitude threatened to bring their normal day-to-day operations to a standstill as staff would’ve had to pour thousands of hours into reprocessing the claims. Their Director of Claims reached out to HCIM and requested two SymKey for EZ-CAP limited duration seat licenses to help recreate and reprice the 300,000+ claims resulting from the retroactive fee schedule change. Instead of taking several months for their staff to adjust the claims, they set up a SymKey scenario to recreate and adjust the claims in a matter of weeks.
- HCIM’s clients have found that the more they expand their utilization of SymKey, the more productive their claims operations are. HCIM is available to help SymKey clients identify and automate additional manual workflows.
- HCIM and MZI HealthCare have been collaborating to identify technology best practices that will improve SymKey and EZ-CAP productivity. For more information, please contact support@hcim.com.
About HCIM
Specializing in Business Process Automation (BPA), HCIM has been delivering technology solutions and consulting services to the managed care/payer industry since 2000. HCIM offers many innovative software solutions, including the SymKey®, ScanClaims®, and Appeals Manager™ product suites, which increase productivity by automating and tracking the adjudication of claims, authorizations, appeals, and provider dispute resolutions. HCIM’s Professional Solutions team offers payer system implementation and configuration, historical data conversions, operational assessments, business process reengineering and analysis, custom report and database development, and ICD-10 impact assessment services.
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