What is SymKey?®
SymKey© leverages IntelliRPA™ robotic process automation to process healthcare claims more efficiently. SymKey processes claims 6-8x faster than an examiner, with 100% accuracy, allowing your staff to focus on more complex tasks. Since it runs entirely through the front-end of your claims system just like any user would, your IT department can rest assured that everything is secure and there’s no direct writing to the database tables.
- Faster – For one client, SymKey completed in two weeks what they estimated would take 142 days
- Accurately – SymKey consistently applies business rules and ensures complete and thorough documentation on the claim
- Cost Effectively – SymKey is an affordable solution that delivers an immediate ROI by increasing auto-adjudication and reducing manual work
What’s Your Biggest Challenge?
Manual Tasks and Processes
Do you struggle on daily basis to eliminate backlogs, reprocess claims and apply retroactive changes, accurately pay multiple surgery claims, or consistently matching authorization to claims all while containing administrative costs? SymKey can automate these scenarios and other more complicated workflows. HCIM’s operations experts will evaluate your current processes and teach you how to leverage IntelliRPA robotic process automation to immediately increase productivity while improving quality.
Repetitive tasks are tedious and create opportunities for costly errors. SymKey is a unique tool created by health plan operations experts that can touch and edit virtually any field within your existing claims platform. Your SymKey robot(s) can run up to 24 hours per day/7 days a week, improving turnaround times and freeing up your existing staff to focus on value-added tasks.
Control Administrative Costs
Healthcare plans and payers are tasked with processing increasing volume, growing membership, and flattening the expense curve by identifying cost saving opportunities and reducing overhead costs. SymKey clients see immediate ROI and shrink FTE staffing costs by automating processes and increasing the efficiency of their operations. HCIM clients also use SymKey to remediate CAP (Corrective Action Plan) issues and ensure compliance.
Create PMPM cost savings and improve payment accuracy with a powerful tool that pays for itself, often within the first six months. SymKey users see an average savings of 2-6 FTEs or more each year while reducing turnaround time.
Resource Constraints
Are critical or routine system support priorities being delayed due to limited resources? Does your operations department lack user friendly tools that give them the opportunity to be more self-sufficient? SymKey bolts onto your existing claims platform with a minimal footprint. HCIM’s proprietary IntelliRPA robotic process automation technology runs on a dedicated workstation(s) inside your firewall and functions as a user would, accessing your system through the front-end interface. Implementations are typically completed in as little as three days and SymKey Manager give users full control over scenarios and business rule customization. SymKey Query Builder is a user friendly tool that enables operations to function without having to submit a support ticket every time.
Health plans ranging from a few thousand to multi-million members leverage SymKey every day to dramatically increase auto-adjudication rates while maintaining high degrees of accuracy with minimal IT support. SymKey is a cost effective tool with a painless implementation, minimal footprint, the ability to scale simply by adding robots.
What Can SymKey Do?
SymKey can touch and edit virtually any claim header or detail line field in your claims system, automating an unending list of your manual workflows. Some examples include:
Reprocess Paid Claims
Reprocess to correct prior paid amounts due to identified over/underpayments
Retroactively Adjust Claims
Reprocess and adjust claims due to retroactive changes to CMS fee schedules, provider contracts, and benefit plans
Duplicate Claim logic
Compare unpaid with paid claims, identify possible dups, deny exact duplicate claims or hard dups based on specific criteria
Deny Claims
Deny based on eligibility, timely filing, benefit limitations, financial responsibility, etc.
Match Authorizations
Link claims to authorizations based on your predefined matching criteria
Add Notes
Add unlimited claim notes and memos, including "Original Received Date" vs "Delegated Entity Received Date” per CMS requirements
exception/outlier Claims
Price unpaid claims due to edits, bundling, DME claims, copay or coinsurance, or outlier contract pricing
Add a Claim Line
Add additional claim detail lines due to bundling/unbundling or splitting lines (i.e. split Professional and Technical)
Apply Overrides
Apply claims processing override codes and/or actions
Member Eligibility
Selecting correct member eligibility segment based on dates of service
Apply CARCs and RARCs
Apply CARCs and related RARCs according to CMS guidelines for adjusting claim lines
Pend for Further Review
Pend claims for examiner audits, high dollar review, or other pre-check run edits
Apply recommended edits
Automatically apply updates from third party applications
Select correct Provider
Choose appropriate provider ID according to business rules
Multiple Procedures
Adjust for member liability and provider payment
Learn more about what SymKey can do for you.
How It Works
Step One
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Implementation
HCIM’s staff works with your team to document common processes and programs these workflows into SymKey. Clients are typically up and running in production within 3 days, resulting in a rapid ROI.
Step Two
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Schedule SymKey
Simply tell SymKey which workflows to run and when, resulting in 24/7 productivity that will virtually eliminate backlogs. You can monitor the progress of claims batches and make changes at any time.
Step Three
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Analyze results
Review and analyze your SymKey reports to refine and optimize your workflows. Users can customize and update workflows as required. Redeploy your staff to work on more critical tasks.
Step four
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Innovate
Revisit your top pend reasons to identify new opportunities and continue to automate workflows. While your claims are being processed by SymKey, your staff is now available to focus on work that requires human intervention.
Comprehensive Licensing, Maintenance, and Support
We use a budget friendly annual license model that includes installation, training, support, maintenance, upgrades, and documentation. HCIM’s product support team collaborates with your organization. We are committed to partnering with our clients to find new and innovative ways to use SymKey to improve their productivity and make their work easier.