{"id":2862,"date":"2010-09-24T10:15:31","date_gmt":"2010-09-24T10:15:31","guid":{"rendered":"https:\/\/www.varshabi.com\/HCIM2\/?p=2862"},"modified":"2021-04-15T15:37:19","modified_gmt":"2021-04-15T15:37:19","slug":"faq-the-2010-cms-fee-schedule-was-released-and-is-effective-retroactively-we-have-already-paid-claims-for-the-last-several-months-that-now-need-to-be-repriced-can-symkey-automatically-reprice-them","status":"publish","type":"post","link":"https:\/\/www.varshabi.com\/HCIM2\/faq-the-2010-cms-fee-schedule-was-released-and-is-effective-retroactively-we-have-already-paid-claims-for-the-last-several-months-that-now-need-to-be-repriced-can-symkey-automatically-reprice-them\/","title":{"rendered":"FAQ: The 2010 CMS Fee Schedule was released and is effective retroactively. We have already paid claims for the last several months that now need to be repriced. Can SymKey automatically reprice them?"},"content":{"rendered":"

Yes, SymKey\u2019s \u201cReprocess\/Pend\u201d standard scenario is a perfect automated solution for repricing paid claims and is very simple to use for EZ-CAP status 9 claims.<\/p>\n

    \n
  1. Create a .txt file with a list of the paid claim numbers that need to be repriced<\/li>\n
  2. Open the SymKey Professional Claims module<\/li>\n
  3. Check the \u201cReprocess\/Pend\u201d checkbox about \u00be the way down on the left side
    \nNote: most of the screen will be grayed out and Source Claim Status 9 will automatically be selected.<\/em><\/li>\n
  4. In the \u201cGlobal Options\u201d section at the top of the Professional Claims module:
    \n\u2013 Check the \u201cReprice Claim Lines\u201d checkbox
    \n\u2013 Check the \u201cAdjustment Code\u201d checkbox
    \n\u2013 Select an adjustment reason from the drop-down list
    \n\u2013 Check the \u201cAdjust All Lines\u201d checkbox<\/li>\n
  5. Click the \u201cProcess Batch\u201d button<\/li>\n<\/ol>\n

    SymKey will automatically perform the following:<\/p>\n

      \n
    1. Create a set of new claims in EZ-CAP status 3<\/li>\n
    2. Duplicate the demographic and line detail for each claim in the input file<\/li>\n
    3. Reprice each line to the new fee schedule<\/li>\n
    4. Subtract the original payment from the amount due, resulting in a net pay of the difference in fee schedule amounts<\/li>\n<\/ol>\n

      Example:<\/strong>
      \nThe original claim paid $45.50 for a particular claim line.
      \nUnder the new retroactive fee schedule, the payment should have been $48.90.
      \nUsing the \u201cReprocess\/Pend\u201d scenario, SymKey will create a new claim with:
      \nClaim Line Contract Value:<\/strong> $48.90
      \nNegative Adjustment:<\/strong> $45.50, with the Adjustment Reason Code specified by the user
      \nClaim Line Net Pay:<\/strong> $3.40<\/p>\n

      If you’re interested in more of the automatic benefits administration solutions that HCIM has to offer, complete the contact form located on the sidebar or e-mail us at info@hcim.com<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

      Yes, SymKey\u2019s \u201cReprocess\/Pend\u201d standard scenario is a perfect automated solution for repricing paid claims and is very simple to use for EZ-CAP status 9 claims. Create a .txt file with a list of the paid claim numbers that need to be repriced Open the SymKey Professional Claims module Check the \u201cReprocess\/Pend\u201d checkbox about \u00be the […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,14],"tags":[38,33],"class_list":["post-2862","post","type-post","status-publish","format-standard","hentry","category-healthcare-information-management","category-symkey","tag-blog","tag-industry-insights"],"_links":{"self":[{"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/posts\/2862","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\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/comments?post=2862"}],"version-history":[{"count":2,"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/posts\/2862\/revisions"}],"predecessor-version":[{"id":16821,"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/posts\/2862\/revisions\/16821"}],"wp:attachment":[{"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/media?parent=2862"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/categories?post=2862"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/tags?post=2862"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}