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# HealthCare Information Management: Turning Complexity into Simplicity.

## Sitemaps
[XML Sitemap](https://hcim.com/sitemap_index.xml): Includes all crawlable and indexable pages.

## Posts
- [Scaling Beyond Your First Automated Workflow: Going from Pilot to Program](https://hcim.com/scaling-beyond-your-first-automated-workflow-going-from-pilot-to-program/): This guide is about what comes after the first workflow. How to scale automation across payer operations without losing the discipline that made the first one work.
- [Build vs. Buy](https://hcim.com/build-vs-buy/): Reading time: 7 minutes · Topic: Payer Operations, Workflow Automation
- [The Hidden Cost of Manual Workarounds in Claims Administration](https://hcim.com/the-hidden-cost-of-manual-workarounds-in-claims-administration/): Manual claims workarounds start as practical fixes, but the hidden cost is rework, delays, staff burden, and reduced visibility across operations.
- [Change Management Adoption](https://hcim.com/change-management-adoption/): Reading time: 8 minutes · Topic: Payer Operations, Change Management, Workflow Automation
- [What to Look For in a Payer Workflow Automation Vendor](https://hcim.com/what-to-look-for-in-a-payer-workflow-automation-vendor/): Choosing a workflow automation vendor for payer operations isn’t the same as evaluating generic enterprise software. Here’s what to look for.
- [Integrating Workflow Automation](https://hcim.com/integrating-workflow-automation/): Reading time: 8 minutes · Topic: Payer Operations, Claims Systems, Integration, Workflow Automation
- [90-Day Payer Workflow](https://hcim.com/90-day-payer-workflow/): Reading time: 8 minutes · Topic: Payer Operations, Implementation, Workflow Automation
- [Why Workflow Automation Should Not Overpromise in Healthcare](https://hcim.com/why-workflow-automation-should-not-overpromise-in-healthcare/): Healthcare workflow automation should be practical, measurable, and realistic. Overpromising creates risk in payer operations.
- [Where Health Plans Lose Time in Manual Administrative Workflows](https://hcim.com/where-health-plans-lose-time-in-manual-administrative-workflows/): Health plans lose time across dozens of small, repetitive workflows that quietly slow down operations every day. Here’s where the leakage hides.
- [Calculate ROI](https://hcim.com/calculate-roi/): Reading time: 8 minutes · Topic: Payer Operations, ROI, Workflow Automation
- [How to Identify Automation-Ready Workflows in Payer Operations](https://hcim.com/how-to-identify-automation-ready-workflows-in-payer-operations/): Not every workflow should be automated. Here’s what payer ops leaders should look for when picking the right candidates for automation.
- [How to Improve Payer Operations Without Replacing Your Core Claims System](https://hcim.com/how-to-improve-payer-operations-without-replacing-your-core-claims-system/): Replacing a core claims system is expensive and disruptive. Here’s how health plans improve operations by automating around the systems they already use.
- [Reducing Claims Backlog](https://hcim.com/reducing-claims-backlog/): Reducing Claims Backlog Without Adding Headcount
- [AI Agents vs. Workflow Automation in Payer Operations](https://hcim.com/ai-agents-vs-workflow-automation-in-payer-operations/): AI agents and workflow automation aren’t the same. In healthcare payer operations, the difference between the two changes how risk, audit, and accountability work.
- [Eligibility Maintenance at Scale: Moving Beyond Manual Exception Handling](https://hcim.com/eligibility-maintenance-at-scale-moving-beyond-manual-exception-handling/): Most eligibility teams spend their time on exceptions, not maintenance. Here’s how to reduce the manual burden of retroactive changes and reconciliation.
- [What Is Operational Leakage in Health Plans?](https://hcim.com/what-is-operational-leakage-in-health-plans/): Operational leakage is value lost through avoidable manual effort, delays, rework, and inconsistent execution: one of the most significant and least visible cost drivers in health plans.
- [FAQ: Workflow Automation for Healthcare Payers](https://hcim.com/faq-workflow-automation-for-healthcare-payers/): Direct answers to common questions about workflow automation in payer operations: what it is, what it isn’t, where it fits, and how to evaluate it.
- [What Is Workflow Automation for Health Plans?](https://hcim.com/what-is-workflow-automation-for-health-plans/): Workflow automation in health plans is software that performs repetitive, rules-based administrative work. Here’s what it does, what it doesn’t, and where to start.
- [Authorization Turnaround: Where the Bottlenecks Actually Are](https://hcim.com/authorization-turnaround-where-the-bottlenecks-actually-are/): Most authorization delays aren’t clinical. They’re administrative: intake, routing, follow-ups, and documentation handoffs surrounding clinical review.
- [5 Payer Workflows Still Running on Manual Effort in 2026](https://hcim.com/5-payer-workflows-still-running-on-manual-effort-in-2026/): Despite two decades of digital transformation, five core payer workflows still consume disproportionate staff time.
- [SymKey 4.2: What Changed and Why It Matters](https://hcim.com/symkey-4-2-what-changed-and-why-it-matters/): Self-service report scheduling, a curated query library, and a modernized UI \u2014 the biggest improvements in the latest release.
- [The Hidden Cost of Manual Provider Data Updates](https://hcim.com/the-hidden-cost-of-manual-provider-data-updates/): One missed provider update can cascade into claim denials, billing errors, and directory compliance issues.
- [Why Generic RPA Fails in Healthcare Payer Operations](https://hcim.com/why-generic-rpa-fails-in-healthcare-payer-operations/): RPA promised to solve everything. But payer operations has unique challenges that generic tools weren’t built for.
- [Cutting Through the OBBBA Noise: Payer Impacts](https://hcim.com/cutting-through-the-obbba-noise-payer-impacts/): The One Big Beautiful Bill Act (OBBBA) brings significant changes that healthcare payers must address to remain compliant, improve operations, and deliver value to their members. From Medicaid funding adjustments to ACA marketplace updates, OBBBA requires strategic preparations. 
- [HCIM Cares: Supporting At-Risk Youth at The Christmas Box International](https://hcim.com/hcim-cares-supporting-at-risk-youth-at-the-christmas-box-international/): HCIM team volunteers with Christmas Box International during All Colleague Meeting, combining hands-on service with $5,000 donation for at-risk youth.
- [SymKey Provider Module Case Study: Imperial Health](https://hcim.com/imperial-health-optimizes-provider-data-management-with-symkey-automation/): Imperial Health uses SymKey Provider Module to automate critical workflows and improve provider data management.
- [What You Need to Know: CMS Announces Aggressive Medicare Advantage Audit Strategy](https://hcim.com/what-you-need-to-know-cms-announces-aggressive-medicare-advantage-audit-strategy/): With new resources, cutting-edge technology, and an expanded workforce, CMS is doubling down on its commitment to integrity and transparency across federal healthcare programs.
- [HCIM Welcomes Cristian Raicea as the Vice President of Software Engineering](https://hcim.com/hcim-welcomes-cristian-raicea-as-the-vice-president-of-software-engineering/): We’re thrilled to share that Cristian Raicea has joined the HCIM team as Vice President of Software Engineering. With over 25 years of experience in the technology industry, Cristian will guide our engineering team into an exciting new chapter of innovation and excellence. 
- [Cristian Raicea](https://hcim.com/cristian-raicea/): VP, Software Engineering
- [Introducing SymKey 4.1 – Taking Reporting to the Next Level](https://hcim.com/introducing-symkey-4-1-taking-reporting-to-the-next-level/): Having precise, actionable data is the key to making informed decisions. That’s why we’re thrilled to announce our latest release, SymKey 4.1. This release has powerful enhancements to improve system monitoring and drive productivity tracking.
- [Medicare Advantage Key Updates](https://hcim.com/medicare-advantage-key-updates/): The Centers for Medicare & Medicaid Services (CMS) are set to implement new regulations for Medicare Advantage (MA) plans starting in 2026. These updates are designed to enhance transparency, streamline administrative tasks, and promote equitable access to healthcare. Significant changes are in the pipeline for provider directories and the prior authorization processes.  Here’s what to expect and how it impacts members and Medicare Advantage plans.  
- [SymKey Unlocks: Eliminating Unwanted Duplicate Lines](https://hcim.com/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.
- [Flexible and Efficient Automation: SymKey Query Builder and Scheduler Features](https://hcim.com/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.
- [Demystifying SymKey Implementation: Quick, Supported, and Flexible](https://hcim.com/demystifying-symkey-implementation-quick-supported-and-flexible/): HCIM prides itself on its hands-on approach during the SymKey implementation. By working closely with your team, we ensure a smooth transition and that SymKey is customized to fit your specific operational needs. This close collaboration significantly reduces the time to go live, with most clients fully operational within 30 days of signing their agreement.
- [Ali Evans](https://hcim.com/team-ali-evans/): Ali Evans is a results-driven business builder. He has extensive experience as an investor and a leader in various operating capacities in healthcare, technology, and financial services. He brings extensive experience in sales, product management, and finance leadership.
- [Chris Weber](https://hcim.com/team-chris-weber/): Chief of Staff and VP,Strategic Finance
- [SymKey Provider Module: Rapid Implementation, Rapid Results](https://hcim.com/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.
- [Trust in Technology: Senate Report Scrutinizes Medicare Advantage Plans](https://hcim.com/trust-in-technology-senate-report-scrutinizes-medicare-advantage-plans/): Technological advancements have the potential to transform healthcare, offering tools for better management and efficiency. However, a recent Senate report presents a critical view of how leading Medicare Advantage insurers like UnitedHealthcare, Humana, and CVS are deploying such technologies. The report uncovers how these insurers have increased their use of algorithmic tools, leading to a surge in denied claims for crucial post-acute care between 2019 and 2022.
- [Provider Survey Reveals the Growing Challenge of Claims Denials](https://hcim.com/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.
- [SymKey Unlocks: Beyond SQL Scripting](https://hcim.com/symkey-unlocks-beyond-sql-scripting/): SQL scripts have long been a staple in healthcare claims processing, managing everything from data updates to claims adjustments. Yet, they carry inherent limitations that can risk data integrity and compliance.
- [Empowering Kindness: How Ben’s Bells Strengthen Communities](https://hcim.com/empowering-kindness-how-bens-bells-strengthen-communities/):  This event wasn't just about crafting beautiful ceramics but a profound exercise in teamwork and empathy, guided by Ben's Bells' mission to educate and inspire communities about the power of intentional kindness. These pieces—part of a larger conveyor of kindness—start as a simple piece of clay and once completed, are hung in public spaces around the globe, waiting to be found by passersby, who are encouraged to take them home as a reminder of the power of kindness.
- [Reduce Manual MIPS Adjustments with SymKey](https://hcim.com/reduce-manual-mips-adjustments-with-symkey/): The 2024 updates to the Merit-based Incentive Payment System (MIPS) significantly impact healthcare professionals, influencing both management practices and compensation for Medicare Part B services. With eligibility criteria encompassing everything from patient volumes to service thresholds, MIPS has set a complex standard that demands precise compliance and operational efficiency.
- [How SymKey Simplifies Sequestration](https://hcim.com/how-symkey-simplifies-sequestration/): Sequestration, a common hurdle for any healthcare payer under Medicare's Fee-for-Service (FFS) program, often involves tedious manual processes. Let's delve into this challenge and discover how SymKey frees you from this time-consuming burden.
- [A Closer Look at the Medicare Prescription Drug Inflation Rebate Program](https://hcim.com/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 financial stress but also offers a layer of predictability and security to Medicare beneficiaries.
- [SymKey Unlocks: Simple Solution to Medi-Cal’s Targeted Provider Rate Increase](https://hcim.com/symkey-unlocks-simple-solution-to-medi-cals-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 on and after January 1, 2024. This regulatory change requires system updates such as: coding, pricing, benefit updates, and in some cases, time-consuming re-adjudicated projects.
- [HCIM Cares:  HCIM Leadership Embraces Community Service at the Durham Rescue Mission](https://hcim.com/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.
- [How a Leading ACO Overcame Systemic Challenges with SymKey](https://hcim.com/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.
- [Scaling New Heights: The Strategic Advantage of Additional SymKey Robots](https://hcim.com/scaling-new-heights-the-strategic-advantage-of-additional-symkey-robots/): SymKey presents a smarter, cost-effective alternative with scalable IntelliRPA technology. By automating repetitive manual tasks, SymKey robots can prevent burnout and maintain consistent quality. Increased demand? Simply add another robot!
- [SymKey Unlocks: Tackling COB Head-on](https://hcim.com/symkey-unlocks-tackling-cob-head-on/): 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.
- [Understanding Auto Adjudication](https://hcim.com/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.
- [My Le Nguyen](https://hcim.com/my-le-nguyen/): My Le Nguyen is the founder and Managing Partner of Lyden Capital.  She has spent two decades investing to build companies in transactions across the technology sector, particularly in the healthcare and education markets.  
- [Julie Klapstein](https://hcim.com/julie-klapstein/): Julie Klapstein was the founding CEO of Availity.  Availity optimizes the delivery of critical business and clinical information among healthcare stakeholders.  During her tenure the company became one of the top clearinghouses and revenue cycle solutions in the country.  
- [Michael Curry](https://hcim.com/michael-curry/): Michael Curry is the Co-Founder and CEO of Lullwater & Co, an operations focused investment company specializing in building companies for the long term. Michael is also Co-Executive Chairman of Apex Physics Partners, a company that he helped to found and lead.
- [Kent Weaver](https://hcim.com/kent-weaver/): Kent Weaver is the founder, CEO and Managing Member of Granite Point. Kent has invested in over 75 middle-market companies as an individual investor and with Granite Point. Kent has partnered with entrepreneurs to build successful businesses such as VRI (remote patient monitoring), Discover Outsourcing (HR outsourcing), Fieldedge (field technician software), mTab (database tool), Neuro International (brain trauma residential), Integra (health provider network), and CALO (teen mental health), among many investments.
- [Exciting New Chapter: HCIM has partnered with Metamora Growth Partners](https://hcim.com/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.
- [Streamlining Payment Processing: A SymKey Success Story](https://hcim.com/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.
- [Understanding the Upcoming Changes in Drug Prices and STLDI Plans](https://hcim.com/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 coverage.
- [SymKey Unlocks Efficiency: 10-Month DME Simplified](https://hcim.com/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 which point they are considered paid up to the purchase price.
- [CMS Proposed Changes: Enhancing Healthcare Access and Coordination](https://hcim.com/cms-proposed-changes-enhancing-healthcare-access-and-coordination/): In a significant stride towards improved healthcare, the Centers for Medicare & Medicaid Services has unveiled its calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS) proposed rule. The comprehensive update outlines a vision for improved coverage, increased access, and more equitable healthcare.
- [Data Integrity: Are you putting your organization at risk?](https://hcim.com/data-integrity-are-you-putting-your-organization-at-risk/): For many payers, mundane tasks such as claim adjustments, recoupments, and retroactive changes are relegated to SQL scripts for the perceived benefit of freeing up more time in their examiner’s day.
- [Enhancing Healthcare Transparency: What You Need to Know](https://hcim.com/enhancing-healthcare-transparency-what-you-need-to-know/): In a recent appearance before the House Energy and Commerce Committee’s Subcommittee on Health, Centers for Medicine & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure spent some time shedding light on the agency’s most recent efforts.
- [Healthcare Spending: 5 Key Post-Pandemic Cost and Utilization Trends](https://hcim.com/healthcare-spending-5-key-post-pandemic-cost-and-utilization-trends/): The COVID-19 pandemic sent shockwaves through the healthcare industry, disrupting healthcare spending and utilization patterns, and leaving a noticeable impact on how we approach healthcare.
- [Case Study: Streamlining Provider Data Management with the New SymKey for EZ-CAP Provider Module](https://hcim.com/case-study-streamlining-provider-data-management-with-the-new-symkey-for-ez-cap-provider-module/): Below is a graph outlining the Request Type and Volume for the following requests:
- [Health Plans Continue to Struggle with Inaccurate Provider Directories](https://hcim.com/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.
- [SymKey Case Study](https://hcim.com/symkey-case-study/): In this case study we will examine how SymKey helped one health plan streamline its claims reprocessing strategies and do the work of ten claims processors with minimal effort. 
- [Is Core System replacement really the best option? What Healthcare Payers need to know before they take the leap.](https://hcim.com/is-core-system-replacement-really-the-best-option-what-healthcare-payers-need-to-know-before-they-take-that-step/): The only constant in healthcare is change. The landscape is constantly evolving, and all the players are feeling the heat to improve care delivery while making healthcare more affordable. There are many factors at play here; new payment methods, regulatory changes, and the need for better engagement and management of the health of members can all disrupt traditional operating models.
- [HCIM Cares: 2022 ACM Giveback at Eddy House](https://hcim.com/hcim-cares-2022-acm-giveback-at-eddy-house/): Northern Nevada’s homeless, at-risk, aged-out foster youth is on the rise. A single night on the streets of Reno alone can claim up to 205 homeless youth under the age of 25 according to the 2020 Annual Homeless Assessment Report (AHAR). Young and afraid, they survive with nowhere to, barely getting their basic needs met. Stepping into those worn-out, second-hand shoes for just a moment makes us all grateful for the fortunate lifestyle that we often take for granted. 
- [Prior Authorization Reforms: Navigating the Road Ahead](https://hcim.com/prior-authorization-reforms-navigating-the-road-ahead/): For the prior authorization reforms being proposed by CMS, interoperability poses a significant challenge. The requirement for payers and providers to improve the electronic exchange of health data, including the need for provider-payer and payer-payer interfaces, will require these systems to work together seamlessly. However, finding a simple solution for interoperability is no small feat.
- [SDOH and Health Equity in 2023](https://hcim.com/sdoh-and-health-equity-in-2023/): The new data collection requirement tells us that 2023 will be the year for walking the walk as far as health equity and SDOH (social determinants of health) are concerned. The Biden administration is pushing a much more holistic approach to healthcare by using data as the main driver.
- [CMS Changes Affecting ACOs in 2023](https://hcim.com/cms-changes-affecting-acos-in-2023/): One of the most impactful changes that we are seeing from the CMS changes for 2023 revolves around behavioral health and the need to make it more accessible to Medicare and Medicaid beneficiaries without all of the red tape that has been required in the past.
- [Problematic Telehealth Claims](https://hcim.com/problematic-telehealth-claims/): Ten years ago, telehealth and telemedicine barely existed. Sure, you might have gotten a call from your doctor or pharmacist for small things, but as far as healthcare is concerned, most visits were completed in-office.
- [Rising Denial Rates: Was it COVID or Human Error?](https://hcim.com/rising-denial-rates-was-it-covid-or-human-error/): If you’ve looked at claim denial data from 2020, you know that in-network claim denial rates were at an all time high. There are a lot of variables that go into approving or denying medical claims, and many of the processes are manual or conducted by humans.
- [How Provider Data Affects Payers and Why You Should Care](https://hcim.com/how-provider-data-affects-payers-and-why-you-should-care/): Data management has been a huge topic of conversation lately, especially Provider data. To many, Provider data feels like it should stay a provider problem, the truth is that it affects healthcare payers in a significant way. Inaccurate or disorganized data can result in negative outcomes for patients and severe financial challenges for health plans.
- [HCIM Cares: Serving Los Angeles’s Most Vulnerable Population](https://hcim.com/hcim-cares-serving-los-angeless-most-vulnerable-population/): Los Angeles is known for many things: the glittering lights, star-studded neighborhoods, unique culture, and Rodeo Drive. The last place that people think of when visiting Los Angeles is Skid Row. 
- [HCFAC Report: FY21 Healthcare Fraud](https://hcim.com/hcfac-report-fy21-healthcare-fraud/): If you are in healthcare, you’ve likely heard of the recently released Annual Report of the Departments of Health and Human Services and Justice. The Health Care Fraud and Abuse Control Program had a lot to report for the 2021 fiscal year, and the results were fascinating but not surprising.
- [Industry Pulse Report: Value-Based Payments, Interoperability, and Healthcare Accessibility](https://hcim.com/industry-pulse-report-value-based-payments-interoperability-and-healthcare-accessibility/): In the 11th Annual Industry Pulse Report, HCEG (HealthCare Executive Group) and WEDI (Workgroup for Electronic Data Interchange) explored the top 10 priorities facing Payers, Providers, and healthcare industry stakeholders.
- [Robotic Process Automation vs AI and Machine Learning](https://hcim.com/robotic-process-automation-vs-ai-and-machine-learning/): Robotic process automation, AI, and machine learning are the most popular technologies. The adoption rate is high, and the curiosity about it is higher, but despite all of this, not all technologies are made the same, and you should know the difference before shopping around.
- [AHIP Report](https://hcim.com/ahip-report/): A recent report from AHIP, Factors Influencing 2023 Individual Market Premiums, provides some insight into the market, government, and economic climate that will affect 2023 individual market premiums. 
- [HCIM Cares: Feeding South Florida](https://hcim.com/hcim-cares-feeding-south-florida/): Hunger in the US is a largely hidden issue that is far more widespread than most know. The pandemic compounded this, and left many families struggling to meet their basic needs. The economic impact of the world on lockdown and the difficulties that families with high-risk family members faced caused many to simply go without. It is estimated that 10.2% of the population faces food insecurity.   
- [Automating Administrative Healthcare Tasks: Taking Advantage of Cost Savings Opportunities](https://hcim.com/automating-administrative-healthcare-tasks-taking-advantage-of-cost-savings-opportunities/): If there is anything positive to take away from the Covid-19 era it would be how it forced health plans and providers to work together and face the tidal wave of stressed healthcare systems by thinking outside the box. The quick adoption of innovative technologies assisted  many to navigate changing policies and uncertain social behaviors, helping health plans and systems surf where they should have floundered.
- [The Future of Improper payments in Medicare and Medicaid](https://hcim.com/the-future-of-improper-payments-in-medicare-and-medicaid/): Every year, thousands (yes, thousands) of Medicare, Medicaid, and CHIP (Children’s Health Insurance Program) payments are paid in error. Whether that is through overpayment on a claim, underpayment, duplicate payments, or payments made to people ineligible for coverage.
- [How to Retain Employees using Intelligent Claims Automation](https://hcim.com/how-to-retain-employees-using-intelligent-claims-automation/): If there's one thing that's been brought to the forefront post-2020, it's the turnover rate in administrative healthcare positions like claims processors. As people left their jobs, the remaining employees became overburdened and started to burn out. What resulted was a revolving door of frenzied hires and resignations; training sprees and two-week notices.
- [The Value-Based Care Model](https://hcim.com/the-value-based-care-model/): At its core, Value-Based Care seems like a no-brainer for the healthcare industry. Simply put, this model rewards providers with incentives based on the quality of the care they provide and outcomes of their patients. Unlike fee for service where providers are paid based on quantity, this alternative model provides cost saving opportunities such as reduced readmissions, improved preventative care, and helps encourage organizations to address important barriers such as social determinates of health (SDOH).    
- [What is the difference between ICD-9 and ICD-10?](https://hcim.com/what-is-the-difference-between-icd-9-and-icd-10/): In many ways, ICD-10-CM is quite similar to ICD-9-CM. The guidelines, conventions, and rules are very similar. The organization of the codes is also very similar. Anyone who is qualified to code ICD-9-CM should be able to easily make the transition to coding ICD-10-CM.
- [Provider Database Accuracy](https://hcim.com/provider-database-accuracy/): The No Surprises Act provides consumers federal protections against surprise medical billing and limits out-of-network cost sharing under many of the circumstances in which surprise bills frequently arise. Surprise billing occurs both for emergency and non-emergency care in which the patient has no control in selecting a provider within their network.
- [Introducing SymKey 4.0](https://hcim.com/meet-symkey-4-0/): We are pleased to announce the release of SymKey 4.0 for EZ-CAP and PCM with an upgraded Batch Manager interface designed for ease of use. The new functionality provides deeper insight into SymKey usage, flexible data filtering options, easier Robot assignment, and customization options for more intuitive end-user views.
- [Preparing for Receipt and Processing of COVID-19 Claims](https://hcim.com/preparing-for-receipt-and-processing-of-covid-19-claims/): Claims processing decision makers are faced with unprecedented challenges and may be evaluating and putting their processes to the test to ensure they are ready to receive and process COVID-19 claims.  They must determine if they are missing some important actions that need to be addressed or implemented in order to quickly and effectively identify COVID-19 claims based on requirements outlined by the Centers for Medicare & Medicaid Services (CMS) and by the Centers for Disease Control and Prevention ( CDC). While many have faced the first wave, now is the time to prepare for the second wave and ensure they have the appropriate processes in place. 
- [HCIM Colleagues Get Creative at A Kid’s Place](https://hcim.com/hcim-colleagues-get-creative-at-a-kids-place/): Giving back to the communities where we live and work is a cornerstone of the HCIM Culture. During our recent visit to Tampa, Colleagues spent the afternoon at A Kid’s Place painting bathrooms, decorating for an upcoming party, working in their donation room, and even provided a little support in their office.
- [Robotic Process Automation: An Overview](https://hcim.com/robotic-process-automation-an-overview/): Robotic Process Automation (RPA) is the technology that allows the software to mimic human actions or interactions and execute business processes. Organizations are facing increased demands on resources, pressuring them to produce more with diminishing or overburdened personnel and RPA is a promising solution to overcoming these challenges. RPA has proven to boost business capacity and provide significant savings in many industry sectors. Although it is a resource that can be used in most, if not all, industries, healthcare has embraced this technology as market demand increases.
- [Streamlining Claims Management](https://hcim.com/streamlining-claims-management/): Effective payer provider collaboration is key to reducing the cost of healthcare, and claims management is an integral component of that relationship. As many organizations focus on care management, they must also streamline claims management processes to evolve with changing reimbursement models. Training and new technologies are at the core of claims management improvement. Technology continues to play an ever-increasing role in collecting patient data and ongoing training ensures personnel stay current with claims management trends.
- [CEO Insight: Healthcare Trends to Watch](https://hcim.com/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 in mind:
- [Core System Replacement Considerations for Healthcare Payers](https://hcim.com/core-system-replacement-considerations-for-healthcare-payers/): New payment methods, accountable care, consumerism and an increasing demand for effective subscriber engagement and management (which disrupts traditional operating models in the small to mid-sized payer market) are placing enormous pressure on providers to innovate and improve operational efficiency. Outdated core legacy systems may hinder a payer’s ability to respond rapidly to this evolving landscape.
- [CEO Insight: Obstacle or Opportunity? Three hurdles facing healthcare payers](https://hcim.com/ceo-insight-obstacle-or-opportunity-three-hurdles-facing-healthcare-payers/): These are challenging times for healthcare payers. Increasing aging populations, pressure to cut costs, and a focus on quality is requiring everyone to do more with less. By facing these challenges head-on, we can turn these obstacles into opportunity. It is through continued innovation and experimentation that we will improve health care delivery in this country.
- [Automation can help commercial healthcare payers and providers save over $11 billion annually](https://hcim.com/automation-can-help-commercial-healthcare-payers-and-providers-save-over-11-billion-annually/): Although the healthcare industry has made some progress in automating claims-related business processes, new findings in the 5th Annual CAQH Index show that widespread adoption of automation processes can result in huge cost savings.
- [Understanding the Next Generation ACO Model](https://hcim.com/understanding-the-next-generation-aco-model/): Accountable care organizations (ACOs) were designed to shift the healthcare industry from the fee-for-service payment model to value-based care, but haven’t always achieved their intended objectives. Based on the successes and limitations of the Medicare Shared Savings Program (MSSP) and the Pioneer ACO Model, CMS launched the Next Generation ACO (NGACO) Model in 2016 to improve the delivery of accountable care. The NGACO Model is intended for ACOs with experience in coordinating care for large patient populations. There are no minimum loss or savings requirements for provider groups in this model, as they take on downside risk and assume nearly all of the risk sharing.
- [What you need to know about miscalculated 2019 MIPS payment adjustments](https://hcim.com/what-you-need-to-know-about-miscalculated-2019-mips-payment-adjustments/): If you are one of the over 418,000 Medicare providers who participated in the 2017 MIPS reporting period, you may want to take a second look at your final score. CMS recently shared an important update announcing the extended deadline for clinicians, groups, and APM entities to review their performance feedback. Now you will have until October 15, 2018 at 8:00pm (EDT) to review important information which will have a direct impact on 2019 MIPS payment adjustments.
- [Colleagues Serve up Fun at New Haven Summer Social](https://hcim.com/colleagues-serve-up-fun-at-new-haven-summer-social/): This past August, HCIM Colleagues gathered from across the country for corporate meetings and our annual giveback event in Houston, TX. This year, we hosted a summer social for residents of Star of Hope's New Haven program, a permanent housing and support ministry for those diagnosed with mental illness and/or substance abuse disorder. Our Colleagues served up pizza and salad, along with a full ice cream bar, an exciting bingo game with prizes, a raffle, arts and crafts stations, and a photo booth. This lively event was the highlight of our week, as we were all moved by the sheer joy and enthusiasm of the residents. Check out these wonderful moments from the summer social.
- [What is the Health Insurance Providers Fee and Who Pays It?](https://hcim.com/what-is-the-health-insurance-providers-fee-and-who-pays-it/): To offset the growing number of uninsured Americans, Congress enacted the Affordable Care Act (ACA) in 2010. With it came provision 9010, establishing the Health Insurance Providers (HIP) fee, a tax that is placed on covered entities that provide health insurance. The intention of this fee was to help fund state marketplaces and exchanges, and the first filing was in 2014.
- [ICD-11 Digitizes Global Healthcare Coding Practices](https://hcim.com/icd-11-digitizes-global-healthcare-coding-practices/): The purpose underlying the International Classification of Diseases (ICD) manuals is to establish a common language to organize and identify diseases and their impacts on human lives. The recent release of ICD-11 promises to further enhance the understanding and control of global diseases. Transitioning to ICD-11 isn't required until 2022, but medical coders will want to need to be aware that it's coming.
- [4 Factors Driving Rising Healthcare Insurance Premiums in 2019](https://hcim.com/4-factors-driving-rising-healthcare-insurance-premiums-in-2019/): Did you know that health insurance companies are already at work setting their premiums for 2019? This year, that endeavor may be more challenging than in previous years; politics, evolving medical costs and actions by independent states are all contributing to the rise of healthcare insurance premiums.

## Pages
- [APG Spring Conference 2026](https://hcim.com/apg-spring-conference-2026/): HCIM at APG Spring Conference 2026
- [Symkey Release 4.2](https://hcim.com/symkey-release-4-2/): Make reporting easier, query building more accessible, and day-to-day work smoother with the latest SymKey release.
- [Elementor Page #24877](https://hcim.com/elementor-page-24877/)
- [Testimonials](https://hcim.com/testimonials-2/): For over 25 years, we've prioritized our clients, earning a Net Promoter Score (NPS) over 90 and the loyalty of longtime customers. We’re proud to be a trusted partner and are grateful for the opportunity to serve.
- [SymKey Provider Module](https://hcim.com/symkey-provider-module/): Automate roster file ingestion and provider data updates accurately in seconds.
- [Stefan Spruill](https://hcim.com/leadership-team/stefan-spruill/): Director of Sales
- [Jay Hammond](https://hcim.com/leadership-team/jay-hammond/): Executive Director of Sales
- [Michelle Graska](https://hcim.com/leadership-team/michelle-graska/): Director, Marketing
- [Kelly Kelly](https://hcim.com/leadership-team/kelly-kelly/): Senior Director, Administration
- [Margaret Cerna](https://hcim.com/leadership-team/margaret-cerna/): Client Success Manager
- [Susan Churchill](https://hcim.com/leadership-team/susan-churchill/): Client Success Manager
- [Cristian Raicea](https://hcim.com/leadership-team/cristian-raicea/): VP, Software engineering
- [CAHP 2025](https://hcim.com/cahp-2025/): For 25 years, HCIM has helped California healthcare payers and managed care organizations improve their operations with purpose-built software.
- [About](https://hcim.com/about/): Founded in 2000, HCIM software is designed and delivered by experienced professionals who understand healthcare operations and the unique challenges payers face.
- [SymKey Claims Module](https://hcim.com/symkey-claims-module/): SymKey processes claims 8x faster than a person and with 100% accuracy, allowing your staff to focus on more complex tasks. 
- [CAHP 2024](https://hcim.com/cahp-2024/): October 21-23 2024
- [Brian James](https://hcim.com/leadership-team/brian-james/): VP, Product Operations
- [Ali Evans](https://hcim.com/leadership-team/ali-evans/): CEO
- [SymKey Eligibility Module](https://hcim.com/symkey-eligibility-module/): With the SymKey Eligibility Module, achieving accurate, efficient, and fast eligibility updates is easier than ever. Automate updates to demographics, new member additions, and changes in health plan details.
- [SymKey Authorizations Module](https://hcim.com/symkey-authorizations-module/): Automate addition, modification, and updates of authorizations to increase speed and accuracy with lower cost.
- [SymKey for QC](https://hcim.com/symkey-for-qc/): HCIM is pleased to bring IntelliRPA(R) automation technology to PLEXIS QUANTUM CHOICE. QC clients can now do more by utilizing SymKey, the intelligent automation solution that processes claims 6-8x fast, with 100% accurately, delivering significant cost savings.
- [SymKey for PCM](https://hcim.com/symkey-for-pcm/): Experts know how to harness technology to improve their operations. Intelligent automation goes beyond and delivers real value.
- [Downloads](https://hcim.com/downloads/): Downloads SymKey Fact Sheet Download SymKey Claims Module Download SymKey Provider Module Download SymKey Authorization Module Download SymKey Eligibility Module Download SymKey for EZ-CAP Payment Processing Module Download SymKey Virtual Auto-Post Download SymKey for PCM Claims Module Download SymKey for Quantum Choice (QC) Claims Module Download
- [SymKey 4.0](https://hcim.com/symkey-4-0/): Introducing SymKey 4.0 HCIM is pleased to announce the latest advancement in IntelliRPA®  robotic process automation. With this exciting new upgrade, users will see enhancements to the Batch Manager interface including new Batch History filtering, changes to the Batch Queue, and Batch Reporting. Upgrade Now Batch Queue Display CustomizationsColumns can be shown or hiddenScreen state automatically saved and restored when logging back inRobot assignment function more accessibleSmarter automatic “On Hold” that auto-releases the hold  Virtual Auto-Post New configuration options to enter VE notes without editing claim and pend claims retaining current user defined status Batch History Extensive filtering and sorting capabilitiesLookup a specific batch numberDisplay Customizations:More columns of information availableColumns can be shown or hiddenFilters and column layouts can be saved and recalledScreen state automatically saved and restored when logging back inSplit batches displayed and reported on as a single batch, with drilldown ability  Batch Reporting Batch detail reports recreated Ability to copy/paste directly from the reportMore flexible export options SymKey 4.0 Resources
- [Culture](https://hcim.com/culture/): Giving back to the communities where we live and work is a cornerstone of the HCIM Culture. During our recent visit to Tampa, Colleagues spent the afternoon at A Kid’s Place painting bathrooms, decorating for an upcoming party, working in their donation room, and even provided a little support in their office.
- [Sign Up](https://hcim.com/sign-up/): Sign Up Receive HCIM perspectives on healthcare news, operations best practices, and technology tools. * indicates required Email Address * First Name Last Name Company
- [SymKey Virtual Auto Post](https://hcim.com/symkey-virtual-auto-post/): SymKey Virtual Auto-Post™ (VAP) was co-developed with PCG Software and seamlessly integrates with Virtual Examiner.  Once Virtual Examiner (VE) Virtual Reporter (VR) generates detailed claim edit recommendations, these edits are applied to the claims automatically by VAP according to clients business rules.  
- [Testimonials](https://hcim.com/testimonials/): Testimonials "SymKey’s price tag was unbelievable! I didn’t think a small company like ours would be able to afford it, but the cost was so reasonable and the ROI was just amazing. I’m seeing a 3x return on my investment!" TAMRA RUYMANNClaims Manager at Physicians of Southwest Washington "My favorite feature is how fast SymKey auto-adjudicated thousands of claims/hour according to our specific needs. We saved at least 1-2 FTEs and expect to realize additional cost savings when we’re able to schedule our reports. Virtual Auto-Post™ saved lots of time by not having to review every single CCI edit pulled by Virtual Examiner®/Virtual Reporter™ – SymKey automatically applied the adjustment reason codes and denied claims as instructed." CHRISTINA ORTIZClaims Auditor at Choice Medical Group "Due to the high volume of reports we have created, we run SymKey almost 24 hours per day. It really eliminates a lot of repetitive manual work." SCOTT FOWLERClaims & Compliance Manager at Southern California Physicians Managed Care Services "SymKey’s abilities contribute to the success of the department. SymKey makes life easier by adding memos and notes, applying adjustment codes, correcting information that was in-loaded incorrectly, adding authorizations and case numbers, adding and/or removing copays, copying claims for adjustments, etc. We LOVE our Symkey and the people behind the product. The customer service is outstanding – they are responsive, helpful, accommodating, friendly, generous with their time and knowledge, and innovative." CLARE ABADIEClaims Director at Desert Oasis Healthcare "I’d estimate that before SymKey, somewhere around 95% of our claims were manually touched in some way. So we decided to let SymKey handle the mundane work, which would allow our processors to focus on analyzing and adjudicating the more complex claims." JOANNE DOSS Claims Delegation Program Manager at Northwest Physicians Network "We’re looking for whatever we can do to automate our business processes accurately and without errors. The less we can do manually, without human intervention, and the more we can do with automated computer processing is the way we want to go. We started with a few companies and kept adding additional SymKey modules and features. As we were growing in size, it just made sense to secure an Enterprise SymKey license. The biggest advantage is the fact that we’re able to get through a large volume of changes that would have previously required a manual touch. We’re seeing faster processing times and reduced FTEs." SCOTT BAESVP of Corporate IS at Heritage Provider Network "I run 80% of my claims through SymKey and the new Batch Manager is heaven sent. I just schedule all my reports and SymKey does its thing, so I don’t even have to look at it." KATHLEEN LEAÑODirector of Operations at Network Medical Management "SymKey’s an asset to our team and is really an ideal employee because it’s incredibly efficient, always does what it’s told, never calls in sick, and won’t ever quit on us. SymKey has allowed us to automate a high volume of claims so our processors can focus on higher priorities and more complex tasks." IPA Administrator at Choice Medical Group "At our rate of growth, we’ve needed to hire more claims processors every year and I was actually down a claims processor when we started our trial, but our productivity has improved so much with SymKey that we don’t need to hire any new claims processors at this point. Because SymKey can handle all the claims we throw at it, we can grow our business with a reduction in hiring." TAMRA RUYMANNClaims Manager at Physicians of Southwest Washington "SymKey has taken our very tedious and quite repetitive manual work and practically eliminated it! We now have time to actually focus on accuracy and proper payment, rather than just data entry. We are becoming true claim examiners. Try and trust. Think outside the box! Understand that SymKey is another examiner, so anything that you can do, SymKey can do it faster with accuracy 100% of the time!" JULIE SPIERTOperations Manager at Tuality Health Alliance "SymKey Virtual Auto-Post freed up examiners from having to manually enter adjustment codes by having VAP do the work. VAP is fast and accurate. Efficiency is the name of the game. The more innovative we are, the more we realize how SymKey can be utilized. We have a new saying around DOHC, ‘How did we ever live without SymKey Virtual Auto-Post?" CLARE ABADIEClaims Director at Desert Oasis Healthcare (DOHC) "We have been able to move many of our homegrown solutions into the SymKey product, which ensures that the rules are applied accurately and consistently. We will soon be expanding the use of SymKey into more auto-adjudication areas, and we are confident that it will continue to improve our productivity." CINDY MARTINCOO at Physicians Medical Group of SC "All I have is SymKey and one auditor. It’s been an easy weekly check run for me." MYRNA JAVIERClaims Manager at Choice Medical Group "I am really enjoying SymKey 3.0. The processing time has gotten faster and my work day has gotten shorter – all of which are a good thing!" SHARLENE RAMEYEDI Analyst, MIS at Bakersfield Family Medical Center "The HCIM staff has been awesome to work with since day one! We really threw some new and interesting challenges at the HCIM staff and they have worked through every complex workflow scenario with us to find automation solutions. Everyone is extremely helpful, quick to respond and readily available to answer all of our questions/concerns. Our only regret is that we didn’t hear about you years ago!" COO at Tuality Health Alliance
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- [Board of Directors](https://hcim.com/board-of-directors/): Member, HCIM Board of Director
- [Leadership Team](https://hcim.com/leadership-team/): Leadership Team Ali Evans is a results-driven business builder. He has extensive experience as an investor and a leader in various operating capacities in healthcare, technology, and financial services. He brings extensive experience in sales, product management, and finance leadership. Learn More Ali Evans CEO Chris Weber is a strategic operator and finance leader dedicated to driving organizational excellence. Learn More Chris Weber Chief of Staff and VP,
Strategic Finance With over 25 years in the technology industry, Cristian is a dynamic engineering leader currently serving as Vice President of Software Engineering at HCIM. Learn More Cristian Raicea VP, Software Engineering
- [Contact](https://hcim.com/contact/): 712 Bancroft Rd., Suite 456Walnut Creek, CA 94598-1531
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- [SymKey](https://hcim.com/symkey/): SymKey is not just another one-size-fits-all automation tool. It’s designed specifically for healthcare payers, leveraging a deep understanding of payer operations to address your unique challenges. By automating cumbersome, manual workflows, we help you achieve faster turnaround times, significantly reduce operational costs, and free your team to focus on their highest priority—delivering outstanding care and support to your members.
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