SymKey for PCM
Experts know how to harness technology to improve their operations. Intelligent automation goes beyond and delivers real value.
Learn how Upper Penisula Health Plan is leveraging their robotic claims examiner to save time and get more done.
SymKey Features
Automatic
SymKey robot(s) run unattended and can be scheduled to run up to 24/7, improving turnaround times and increasing accuracy
Flexible
Users can define manual processes, customize, and make updates as business needs change, allowing your staff to focus on more analytical tasks
Auditability
SymKey logs all actions processed for comprehensive reporting
SymKey Automated Workflows
Duplicate Claim Logic
Manage duplicate claims for review and/or denial
Reprocess Claims
Process retroactive Medicare, contracting, or other fee schedule changes
Deny Claims
Deny claims or claim lines for services outside delegated responsibility and forward to health plan and/or tertiary network
Exception/Outlier Claims
Evaluate when copay and coinsurance is no longer being deducted for 10-month DME
Price or Calculate
Price or calculate benefits or contract terms through an external pricer
Provider or Vendor Corrections
Correct a group of claims for a provider with an incorrect vendor or servicing provider
Referral/Authorization Updates
Re-adjudicate claims after the referral/authorization
is mapped
Special Provider Contracts
Calculate pricing and withhold, override benefit paid and withhold, enter EOB code and set status
SymKey Manager and Processing Engine Setup
Workstation Requirements, Pre-Install Checklist
Capabilities
Tuality Health Alliance (THA) is a physician-hospital community organization that contracts with over a dozen health plans. Within the first month, THA was processing an average of 400 claims per hour with SymKey®, at speeds 8x faster than manually.
“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. WE LOVE IT!”
