Claims are divided into two primary parts: the claim header, which contains essential details like member, provider, and location, and claim lines, which represent the services performed. While this structure supports efficient organization, specific scenarios – such as creating new claims – can result in unintended line duplication.
The Problem
- Unexpected Line Duplication: When a new claim is created to reprocess a paid claim or to copy information between databases, the adjudication system may generate an extra line identical to the final service line.
- Administrative Burden: Claims examiners must manually detect and remove these duplicates, which creates extra manual work and delays processing time.
- Financial Risk: Duplicate lines can cause inaccurate reimbursements or confusion during audits.
Thorough Solution
The SymKey automated process addresses this issue with a targeted, two-pronged approach:
- Replicate the Original Claim: A custom workflow copies the paid claim precisely as is, retaining the header and each line correctly.
- Spot and Remove the Duplicate Line: A specialized query verifies that no extra lines have been added, restoring the claim’s accuracy.
By automating the detection and correction process, SymKey ensures that the output is free from common data entry errors, enhancing precision. It also reduces the time spent on manual data verification, allowing your team to focus on more critical aspects of claims management and improving efficiency.