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 Functionality
Reprocess Claims
SymKey can duplicate claims and optionally negate the original, adding an additional information line to cross reference the original claim to the duplicated claim.
Adjudicate Claims
SymKey can utilize QC’s Adjudication functions to re-adjudicate claims and clear adjudication.
Override Result Codes
SymKey can approve, deny, pend, and hold claim lines by overriding their result code statuses. SymKey can also override claim header result code statuses.
Add Result Codes
SymKey can add result codes to claim lines.
Change Claim Status to Denied
SymKey can utilize QC’s Change Claim Status function to override : line statuses to Denied, effectively denying the entire claim.
Override Payment Amounts and Adjudication Fields
SymKey can add result codes to claim lines.
Remove Claim Line Payment, Adjudication, and Result Code Overrides
SymKey can clear all overrides from the claim line payment details and adjudication details, clear all result code overrides, and delete all user-entered result codes, effectively restoring the claim to its original adjudicated state.
Add and Delete Claim Additional Info
SymKey can enter new additional information lines on the claim, as well as delete existing lines.
Add Claim Notes
SymKey can add notes to claims, setting any of the fields on the note.
Example Scenarios
Approve Claim Line
Professional claim service line CPT 35415 is on Hold with amount <= $23.99. SymKey can be told to approve the claim line by overriding the result code status from Hold to Approve and re-adjudicate the claim.
Apply Subrogation Denial
Result code QC0036 is present when there is possible subrogation due to the patient’s accident being employment related, auto accident, or other accident. SymKey can override the status of result code QC0036 to Deny and add an appropriate explanation result code: WORK, SUBROACC, or SUBROAUTO, then re adjudicate the claim.
Reprocess Claim
Reprocess claims where the copay was taken in error, the contracted amount was originally wrong, or the CARC/RARC on a claim line was incorrect. SymKey can duplicate the paid claim, negate the original paid claim, and then adjudicate the duplicated claim which will now pay correctly based on the corrected configuration in QC.
Veterans Administration Cross Billing
When the patient is a Veteran, bill the Veterans Administration on a separate claim. SymKey can duplicate the claim, referencing the duplicate claim number on the original claim, then adjudicate and add HNCLIN result code to all lines on the duplicate claim with its status set to Approve, and finally override the claim header result code to a Hold status to wait for payment to be received from the Veterans Administration.
Early Adopter Program FAQs
- Discount on 1st and 2nd Year SymKey license fees
- Discount on implementation fees
- Provide input on the features of the SymKey Professional and Institutional Claims modules
- Get access to use functionality prior to General Release
- Join before 4/30/2022
- Client input/direction into SymKey for QC functionality
- Collaboration on product features
- Early access to features and enhancements
- Tiered pricing by membership
- Early Adopter program discounted license fees for first and second license years
- Discounted implementation fees
- Increased collaboration and input into the product
- Participate in regular meetings to drive release content
- Equal representation regardless of “client size”
- Active involvement in the testing phase
- Early access to SymKey for QC Professional and Institutional Claims processing functionality
- Automate repetitive processes
- Reduce manual claims-related tasks
Step 1: Early Adopters Input Gathering
- Early Adopters, individually and as a group, review/provide input to product features
- Coordinated by HCIM
- Complete product feature survey
- HCIM analyzes results
- Early Adopter group discussion
- Clients can “present the case” for specific features
- Clients individually rank the list
- Opportunity to reprioritize list
- Opportunity to add product function
Step 2 – Early Adopters Design sessions
- HCIM/Early Adopter members participate in design sessions
- HCIM creates business requirements documents to include:
- Priority levels assigned
- Early Adopter members review business requirements documentation for accuracy
- HCIM will incorporate agreed upon features into the Professional and Institutional Claims modules
- Early Adopter will provide HCIM access to an QC test environment
- Early Adopter will review test cases for user scenarios and provide feedback
Step 3 – Early Adopters – Product Delivery
- Development/delivery process
- Participate in monthly status reviews run by HCIM
- Progress to date
- Need for Change Control discussed
- Provide a Monthly Status Report
- SymKey for QC module functionality will be delivered to Early Adopter members prior to general release dates
- One time discounted first year implementation fee of $25,000
- Includes implementation of interim and final releases
- User and Technical documentation
- Covers all implementation services
- License fees Tier based
- Determined by membership size, split into payments the first year
- License Fees are discounted for the first and second license years
Initial Early Adopter implementation fee due 30 days after agreement execution
- Early Adopter program effective date is 3/1/2022
- How do I join?
- Contact Wayne Johnson and request Early Adopter agreement
- Sign-up period runs 3/1/2022 to 4/30/2022
- Execute Early Adopter agreement
- Participate in surveys/discussions soliciting enhancements/feedback
- Vote on functionality at Early Adopter meetings
- Product Development Committee includes
- One representative from each Early Adopter client
- Help to identify, review, and finalize potential features
- Promote the Early Adopter program to other clients
- Provide a QC test environment for SymKey testing
- Provide access to QC test data to query and external file sources for SymKey
- Provide a machine for SymKey testing and HCIM remote access
- Allocate a resource to be available for testing and be committed to test on a timely basis
- Provide testimonial after the release of the SymKey for QC Professional and Institutional Claims modules
Download Early Adopter FAQs
Wayne Johnson
Asst. VP, Product Client Development and Sales
wjohnson@hcim.com
925-336-7796
