SymKey Unlocks: Simple Solution to Medi-Cal’s Targeted Provider Rate Increase
The recent California Department of Health Care Services (DHCS) amendment to the AB 118 bill has Medi-Cal managed care health plans working overtime implementing this bill. This provision is increasing Medi-Cal rates for eligible contracted providers to equal no less than 87.5% of the lowest Medicare rate who supply treatment for certain Medi-Cal services rendered […]
HCIM Cares: HCIM Leadership Embraces Community Service at the Durham Rescue Mission
North Carolina’s capital, Raleigh, played host to HCIM’s recent Leadership Team Meeting. In the midst of strategic discussions, the team took a meaningful detour to support the local community. Their destination was the Durham Rescue Mission, the oldest homeless shelter in the Durham, Raleigh, and Chapel Hill area. Founded in 1974 with a steadfast mission […]
How a Leading ACO Overcame Systemic Challenges with SymKey
A leading ACO (Accountable Care Organization) and medical group manager faced significant challenges with its claims adjudication processes due to poorly designed auto-adjudication rules. These rules caused continuous claim cycles, creating ongoing issues. Their wide range of operations across rural areas, multiple service organizations (MSOs), and specialized environments, further complicating the situation. Facing the Adjudication […]
Scaling New Heights: The Strategic Advantage of Additional SymKey Robots
When faced with increasing claims volumes or special projects like large-scale reprocessing, many healthcare payers look to traditional solutions such as hiring more staff or mandating overtime for existing staff. Both options come with drawbacks; hiring can be a lengthy process along with significant training investment. Even temporary help requires training and supervision that often […]
SymKey Unlocks: Tackling COB Head-on
The COB Challenge Coordination of Benefits (COB) – the perpetual headache for healthcare payers. Manual processes, incomplete member questionnaires, and the eternal struggle of determining the order of benefits. The result? Delayed payments, increase in appeals such as over payment and under payment of claims, and an increase of claim pend ratio. System Limitations Many […]
Understanding Auto Adjudication
Auto adjudication is the process of swiftly processing insurance and public benefit claims, without the need for manual intervention or decision-making for each claim. In essence, it’s about harnessing the potential of technology and smart system configuration to handle claims automatically. It’s often misconstrued as a straightforward process. Configure certain rules and parameters, set up […]
Exciting New Chapter: HCIM has partnered with Metamora Growth Partners
HCIM is excited to announce as of April 2024 we have partnered with Metamora Growth Partners, marking a significant milestone in our journey. This partnership presents an exciting opportunity for HCIM to enhance our existing offerings and continue providing innovative solutions tailored specifically for healthcare payers. “The drive to serve has been at the heart […]
Streamlining Payment Processing: A SymKey Success Story
Ensuring the payment process is accurate, efficient, and timely is crucial for healthcare payers. The SymKey Payment Processing Module is a tool to help streamline the check run process and provides flexibility to make corrections and safeguard proper payment. SymKey Payment Processing Module runs against the claim system database and via Excel or CSV files […]
Understanding the Upcoming Changes in Drug Prices and STLDI Plans
In a major move toward healthcare reform, the HHS along with the Departments of Labor and the Treasury have proposed provisions that address critical issues in the realms of prescription drug pricing and Short Term, Limited-Duration Insurance (STLDI) plans. These actions reflect a commitment to empower consumers and ensure they have access to quality healthcare […]
SymKey Unlocks Efficiency: 10-Month DME Simplified
Manual claims processing can be a costly, time-consuming process marred by potential errors. This is especially true for Durable Medical Equipment (DME) 10-month rentals, which are a complex but crucial part of patient care. Physicians order equipment that provides therapeutic benefits to the patient, and these rentals cover a period of 10 continuous months, at […]