SymKey Provider Module
IntelliRPA® technology designed for more than just claims adjudication. SymKey® robots help you better manage your Provider Data with the same accuracy, consistency, and speed you trust.
Key Features
Term Provider’s Contracted State
SymKey can term an existing provider. Terming a provider’s contracted state usually involves 1) terming the following data elements to a specific date and 2) adding non-contracted/out-of-network records from the term date going forward:
- Contract type code
- Vendor association
- HMO/PPO in-network status by health plan, vendor, and specialty
- Fee set assignments specific to the provider
Add Providers
SymKey can add new providers along with one or more vendors, specialties, health plans, fee set assignments, and locations (contacts/addresses)
Update Demographics
SymKey can update these provider demographic fields on existing providers:
- Last Name
- First Name
- Middle Name
- Suffix
- Birthdate
- Gender
- RBRVS Carrier and Locality
Update Contract Type Code and Class Code
SymKey can update the provider’s contract type code and class code along with their effective and term dates. SymKey can term the existing contract code by adding a new “current” contract type code record, as well as term the existing class code by adding a new “current” class code record. SymKey can also add historical contract type code records and class code records.
Add, Update and Term Locations (Contacts/Addresses)
SymKey can update these fields on existing provider contacts (locations) and add new contacts (locations):
- Address fields
- Phone numbers
- Email addresses
- Effective dates (from and to date)
- Which is the default and which is the physical/billing address
- Contact person, designation, department, and language
Add, Update, and Term Vendor Associations
SymKey can update existing vendors associated with the provider and add new vendor associations.
Add Specialties
SymKey can add specialties to a provider, including these fields:
- Specialty Type
- Specialty Code
Add, Update, and Term Health Plan Panels
SymKey can update existing health plan panel HMO and PPO records and add new HMO and PPO records including updating these HMO/PPO fields:
- In-Network/Out-of-Network
- Specialty code
- Vendor ID
- Start and Term dates
- Status code
SymKey can add new health plan panels to the provider, including setting the membership start date and adding HMO/PPO records.
Add Notes
SymKey can add one or more notes to a provider.
Update Memo Lines and User Defined Fields
SymKey can update the four memo line fields and all twenty user defined fields on an existing provider.
Add, Update and Term Fee Set Assignments
SymKey can add and update fee set assignments specific to the provider, including adding notes. SymKey can also add current and historical records to existing fee set assignments specific to the provider.
From the Blog
Case Study: Streamlining Provider Data Management with the New SymKey for EZ-CAP Provider Module
Maintaining Provider Data accuracy is one of the most common challenges for payers in the healthcare industry, and good reason. It can be overwhelming and, at times, very challenging to
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
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