HealthCare Information Management, Inc: Simplifying Healthcare Payer Operations through Claims Automation

Michael Wilson, President & CEO
Healthcare is going through some of the greatest changes that we’ve ever seen, including the need to implement technology in the cloud, ACA Operating Rules, the Health Insurance Exchange, ICD-10, and other regulatory mandates. There’s also a big drive to become more efficient because of the mandated medical minimum loss ratios (MLR). “Leveraging automation technology to reduce operational costs is an innovative way to address these challenges,” said Michael Wilson, President & CEO at HealthCare Information Management, Inc. (HCIM). “In the coming years, the adoption of new technology must be a high priority for CIOs in this rapidly evolving healthcare marketplace. HCIM’s software solutions and consulting services position clients to overcome these hurdles and successfully compete.”

HCIM’s flagship SymKey® software solution is an automation tool that performs a predefined series of actions on hundreds of claims at a time within a client’s existing claims system. SymKey® automates and adjudicates the manual repetitive claims actions in order to free up claims staff for complex and analytical tasks. SymKey® has the ability to touch and edit any claim and header field and processes claims six to eight times faster than manual adjudication. It can run unattended 24/7 so it can easily handle the biggest backlogs.

Earlier this year, Foundation for Medical Care of Tulare & Kings Counties began a 30-day SymKey® trial in hopes of improving their turnaround time, which had gone from 5-7 days to over 40 days within a span of two months due to system issues. They decided to purchase SymKey® two weeks into the trial and were able to drastically improve their turnaround time and save FTEs in the process. “Our best-of-breed product helps our customers reduce inventories and optimize accuracy, leading to a rapid Return on Investment and significant time and cost savings,” said Wilson “With the recent onslaught of PHI breaches and cyber-attacks, CIOs must be more cautious than ever,” said Wilson.“We use Egnyte secure file sharing for both internal and external file transfers whenever dealing with potential PHI in order to comply with HIPAA regulations.” HCIM’s solutions do not extract out PHI or protected data – they run and store data inside the client’s network, which safeguards against the interception of protected health records.
“We’re continuing to expand SymKey® onto additional leading benefit administration core claims systems and are currently developing our 4th generation of the SymKey® architecture, which will leverage true data table integration thereby eliminating the transfer of data files between applications,” said Wilson.

HCIM offers the Claims Audit Tool™ (CAT), which saves money by reducing overpayments, underpayments, adjustments, and rework. “CAT is the auditor’s workflow tool, which offers a robust pre and post-payment audit to enhance the productivity of claims audit units, and facilitate/automate error identification at a minimal cost, saving millions of dollars each year,” said Wilson.

Our best-of-breed product helps our customers reduce inventories and optimize accuracy, leading to a rapid Return on Investment (ROI) and significant time and cost savings.

HCIM also provides an ICD-10 Training program for primary care providers, specialists, ancillary providers, and more. “Even though October 1, 2015 has passed, it’s not the end of ICD-10. It’s only the beginning for the providers,” said Wilson. HCIM delivers ongoing training and education through ICD-10 webinars, online training courses with continuing medical education (CME) credits and a mobile friendly coding/reference software tool.

With a solid reputation after 15 years, HCIM is introducing a Value Based Strategic Consulting Practice to assist health plans, health systems, and ACOs in meeting strategic initiatives, achieving industry compliance, creating technology and operational efficiencies, and transforming their organizations to meet the demands of the changing healthcare environment.

HealthCare Information Management, Inc.

Walnut Creek, CA

Michael Wilson, President & CEO

Provider of claim automation solutions and consulting services for healthcare payers and managed care organizations.