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 years.

SCPMCS used SymKey® to assist in the processing of nearly 335k claims last year, which they estimated was equivalent to the workload of 3 full time employees (FTEs).

In addition to saving SCPMCS approximately 3 FTEs per year, the sheer speed of claims processing with SymKey® has ensured they maintain impressive turnaround times. Their claims team’s confidence in the accuracy of claims processed with SymKey® allows them to focus on more complex tasks, resulting in efficient and streamlined claims operations.

According to the SCPMCS claims team, their favorite SymKey® workflow scenario is Copy and Reverse, which allows them to create exact claim copies to rework paid claims and reverse them. This is particularly useful when CMS releases a retroactive fee schedule adjustment, because those Medicare FFS claims can be reprocessed quickly and accurately, with minimal human intervention. Learn More >>

“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,” said Scott Fowler, Claims & Compliance Manager at SCPMCS.

SymKey® features full sequencing and scheduling capabilities, which allows it to be run 24/7. Strategically, SymKey® allows small to mid-sized healthcare payer organizations to grow with minimal disruption to their claims operations. SymKey® clients can increase their membership and process an ever-increasing number of claims without hiring more claims processors to work the additional claims. SymKey® can never be maxed out in capacity because clients can add additional processing engines to handle an influx of claims.

“Based on SCPMCS’ FTE savings, we estimate that they realized a 110% return on their annual license fees,” said Thomas Streeter, Senior Vice President, Product Solutions at HCIM. “This impressive ROI demonstrates how forward-thinking and innovative their claims operations team is, always looking for more workflows to automate with SymKey® robotic processing.”

After nine years as a valued SymKey® client, SCPMCS has continued to receive the attentive product support they’ve come to expect from HCIM. “We are extremely pleased with SymKey® and have found HCIM’s customer support to be outstanding,” said Fowler.

“At HCIM, we are passionately committed to our clients. I’ve enjoyed our long-term partnership with SCPMCS and am pleased that they consistently embraced SymKey® as an integral component of their daily claims workflow. Their success is truly our success. I am delighted to see that they’ve been able to achieve operational efficiencies year after year,” said Michael Wilson, President & CEO of HCIM.