A Closer Look at the Medicare Prescription Drug Inflation Rebate Program
The launch of the Medicare Prescription Drug Inflation Rebate Program is a vital development for the financial and medical well-being of millions of Americans, specifically designed to ease the financial burden of prescription medications for seniors and individuals with disabilities. By instituting an annual out-of-pocket (OOP) cap on drug costs, the program not only alleviates […]
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 […]
CEO Insight: Healthcare Trends to Watch
The healthcare payer landscape changes almost daily and it can be hard to see the forest through the proverbial trees. It’s easy to get focused on the day to day and miss important trends that may have significant impact down the road. As we look to the future, it’s important to keep these key trends […]
Southern California MSO using AI to increase claims processing productivity
While many businesses are still looking for ways to harness new technology, Southern California Physicians Managed Care Services (SCPMCS) has been leveraging artificial intelligence to increase the productivity of their claims team since 2009. Using HCIM’s SymKey® solution, SCPMCS has been able to automate both routine and on-the-fly claims processing workflows for the past nine […]
How to Automate the Reprocessing of Medicare FFS Claims Due to the Bipartisan Budget Act of 2018
Healthcare payer organizations that use the Medicare fee schedule must begin reprocessing claims as of last week. Due to provisions in the Bipartisan Budget Act of 2018 that was passed on Feb. 9, CMS issued Change Request 10531 directing payers and Medicare Administrative Contractors (MACs) to reprocess FFS claims relating to Medicare Extenders (the Medicare […]
The Business of Bots: The SymKey® Effect
HCIM has been in the business of bots for over 15 years, operating exclusively in the healthcare claims industry. Our passion has always been to optimize processes through Robotic Artificial Intelligence. SymKey® automates manual repetitive claim actions while at the same time thoughtfully applying business rules and ensuring quality claim payment. Clients enjoy the fast turnaround times, […]
There’s No Shortage of AI Specialists Here
A recent Ernst & Young study revealed that a shortage of artificial intelligence experts is impeding the ability of companies to adopt the technology. In fact, over half of the executives surveyed claimed the lack of available talent prevented them from integrating AI into their business operations. This directly impacts their competitive advantage in streamlining […]
