{"id":22336,"date":"2024-07-29T17:00:32","date_gmt":"2024-07-29T17:00:32","guid":{"rendered":"https:\/\/www.varshabi.com\/HCIM2\/?p=22336"},"modified":"2024-08-01T15:07:39","modified_gmt":"2024-08-01T15:07:39","slug":"how-a-leading-aco-overcame-systemic-challenges-with-symkey","status":"publish","type":"post","link":"https:\/\/www.varshabi.com\/HCIM2\/how-a-leading-aco-overcame-systemic-challenges-with-symkey\/","title":{"rendered":"How a Leading ACO Overcame Systemic Challenges with SymKey"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"22336\" class=\"elementor elementor-22336\" data-elementor-post-type=\"post\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a00fbf9 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"a00fbf9\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-953a2e3\" data-id=\"953a2e3\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1950cd9 elementor-widget elementor-widget-text-editor\" data-id=\"1950cd9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>A leading ACO (Accountable Care Organization) and medical group manager faced significant challenges with its claims adjudication processes due to poorly designed auto-adjudication rules. These rules caused continuous claim cycles, creating ongoing issues. Their wide range of operations across rural areas, multiple service organizations (MSOs), and specialized environments, further complicating the situation.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c013fda elementor-widget elementor-widget-heading\" data-id=\"c013fda\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Facing the Adjudication Challenges<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5b729c4 elementor-widget elementor-widget-text-editor\" data-id=\"5b729c4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>HCIM traced the root cause back to poorly designed auto-adjudication rules. Timely Filing was one of the settings that were configured, and a rule was created for. There was a rule to auto deny the claims that were submitted untimely. However, there are special provider contracts that have a custom number of days to submit claims, not the standard settings from the Timely Filing configuration. These claims were being adjudicated incorrectly, being paid or denied incorrectly. \u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-21089ce elementor-widget elementor-widget-heading\" data-id=\"21089ce\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">SymKey's Transformative Role in Claims Processing<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d2ecaa4 elementor-widget elementor-widget-text-editor\" data-id=\"d2ecaa4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Understanding the unique needs and complexities of the organization, HCIM proposed a dual-pronged solution. First, by establishing a specialized query that acknowledges both standard and unique provider agreements. Second, by setting up a reference table that aligns with specific submission deadlines. This approach ensured that each claim is assessed accurately, respecting the unique terms agreed with specific providers.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2b9ed5d elementor-widget elementor-widget-heading\" data-id=\"2b9ed5d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Kev Benefits Realized<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9af789f elementor-widget elementor-widget-text-editor\" data-id=\"9af789f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>The strategic overhaul and SymKey implementation delivered several compelling benefits:<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d112ad0 elementor-align-start elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"d112ad0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-circle\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\"><b>Increased Accuracy:<\/b>  The precise alignment of claims with contract-specific deadlines virtually eliminated the erroneous denial of claims.<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-circle\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\"><b>Operational Efficiency:<\/b> With the removal of faulty configurations, the claims process became smoother and faster, significantly reducing cycle times.<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-circle\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\"><b>Reduced Administrative Strain:<\/b> The automation of nuanced adjudication rules reduced the need for manual interventions, allowing staff to focus on more critical tasks.<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4c0cb17 elementor-widget elementor-widget-text-editor\" data-id=\"4c0cb17\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>These enhancements have empowered the organization to not only meet but exceed their operational efficiency goals, significantly reducing administrative burden and increasing accuracy.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-04a8c27 elementor-widget elementor-widget-spacer\" data-id=\"04a8c27\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e045acd elementor-widget elementor-widget-spacer\" data-id=\"e045acd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>A leading ACO (Accountable Care Organization) and medical group manager faced significant challenges with its claims adjudication processes due to poorly designed auto-adjudication rules. These rules caused continuous claim cycles, creating ongoing issues. Their wide range of operations across rural areas, multiple service organizations (MSOs), and specialized environments, further complicating the situation. Facing the Adjudication [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":22381,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,14],"tags":[101,57,30],"class_list":["post-22336","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-healthcare-information-management","category-symkey","tag-claims-processing","tag-hcim","tag-symkey"],"_links":{"self":[{"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/posts\/22336","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/comments?post=22336"}],"version-history":[{"count":10,"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/posts\/22336\/revisions"}],"predecessor-version":[{"id":22384,"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/posts\/22336\/revisions\/22384"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/media\/22381"}],"wp:attachment":[{"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/media?parent=22336"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/categories?post=22336"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/tags?post=22336"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}