SymKey Unlocks: Eliminating Unwanted Duplicate Lines
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 […]
Flexible and Efficient Automation: SymKey Query Builder and Scheduler Features
As healthcare providers continually seek ways to improve efficiency, SymKey’s user interface delivers flexible automation and user-friendly features. Query Builder and Query Sequencer: Craft SQL statement and Query Sequencer that automatically run one query after the other, in a unique order within SymKey to handle complex claims processing scenarios. This tool is indispensable for creating […]
SymKey Provider Module: Rapid Implementation, Rapid Results
The recent deployment of the SymKey Provider Module at a Management Services Organization (MSO) in Southern California highlights our commitment to delivering quick solutions with immediate impact. Completed in just 30 days, the implementation process was smooth and efficient, leading to impressive productivity in the first two months. Performance Overview in the Initial Two Months: […]
Provider Survey Reveals the Growing Challenge of Claims Denials
In recent years, healthcare providers have faced increasing challenges with claims denials, a trend that has worsened significantly since 2022. According to Experian Health’s 2024 State of Claims survey, the primary culprits for these denials include prior authorizations and inaccuracies in data submission. The survey gleaned insights from 210 healthcare staff members responsible for administration […]
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 […]
Case Study: Streamlining Provider Data Management with the New SymKey for EZ-CAP Provider Module
Maintaining Provider Data accuracy is one of the most common challenges for payers in the healthcare industry, and good reason. It can be overwhelming and, at times, very challenging to keep up with constant weekly and monthly changes to ensure that data is updated promptly, especially when it’s a large provider data update. But as […]
Health Plans Continue to Struggle with Inaccurate Provider Directories
Unexpected medical bills are a common issue that many patients face. In 2020, the Federal government passed the No Surprises Act to protect patients from these unexpected bills and increase transparency in the healthcare industry. The No Surprises Act included provisions requiring healthcare payers to make timely updates and maintain their provider directories in an […]
