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 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.
