HealthCare Information Management, Inc.: SymKey® Robotic Process Automation for Healthcare Claims

Thomas Streeter, SVP of Product Solutions
As the healthcare industry undergoes dramatic regulatory and operational changes due to mandates such as the Affordable Care Act and the move to value-based care and payment models, every healthcare organization is facing the need to reduce administrative costs and streamline their processes. They must find ways to be more efficient through the application of integrated technology systems and automation solutions. HealthCare Information Management, Inc. (HCIM) saw this need 16 years ago when they built SymKey®, the first robotic claims automation tool to hit the market.

SymKey® was the brainchild of Michael Wilson, HCIM’s co-founder and President & CEO, birthed from his years of claims operations management experience. Initially programmed by Thomas Streeter, HCIM’s Senior Vice President, Product Solutions, SymKey® is the business process automation tool that Wilson had always dreamed of while he was working in claims operations—an automated claims processing engine that could post claim edits and automate routine manual workflows within the client’s existing claims transaction system with 100 percent accuracy, both improving turnaround times and reducing claim backlogs.

“SymKey® has evolved through the years in response to the needs of HCIM’s clients and has become such an integral part of so many clients’ claims operations that one customer coined the phrase, ‘How did we ever live without SymKey®?’” said Streeter.

Using programmed artificial intelligence, SymKey® can touch and edit any field on the claim form according to each client’s unique business rules and can be scheduled to run at any time, day or night. This frees up claims staff for more complex and analytical tasks. “With full reporting capabilities and jaw-dropping productivity stats, clients can see how much time they saved and measure their ROI,” said Laurie Kirkland, HCIM’s Director of Sales and Marketing.

A recent SymKey® client, Foundation for Medical Care of Tulare and Kings Counties (The Foundation) experienced a 75 percent drop in claims productivity when they upgraded their claims management software. Their turnaround time went from 5-7 days to over 40 days within two months. After only two weeks of using SymKey®, The Foundation had drastically improved their turnaround time and saved FTEs in the process. Had they not found SymKey®, The Foundation would have fallen even further behind with no end in sight.

HCIM’s innovative SymKey® robotic productivity tool utilizes artificial intelligence to automate healthcare claims processing and streamline operations

It’s time consuming to train new staff, but with SymKey® they experience no loss of production when they increase their membership or when staff is out of the office.

This year, HCIM surveyed 80 percent of their clients and found that for those organizations alone, SymKey® had processed over 7.8 million claims in 2015, completing the work of approximately 264 claims examiners and resulting in FTE savings of over $12 million. SymKey® clients averaged a 10x return on their investment in that time. “I’m excited at the prospect of where we will be with SymKey® technology 5-10 years from now, as we’ll be expanding the product line onto additional claims systems, with expanded functionality and valuable interfaces to 3rd party systems,” said Streeter.

The Claims Audit Tool™ (CAT) is another productivity solution that HCIM offers, which is designed to be used in the claims audit departments of organizations paying healthcare claims. CAT utilizes flags and predefined filters to automate claims audits and save money by reducing overpayments, underpayments, adjustments, and rework. CAT is the auditor’s workflow tool, offering 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 clients millions of dollars each year.

HCIM also provides Professional Consulting Services such as payer system implementation and configuration, data migration, report development, operational assessments, project management, and staff augmentation. Additionally, HCIM is now offering Strategic Consulting to help clients tackle the industry’s toughest challenges, including the transformation to a value-based care model, regulatory compliance, medical management optimization, data analytics, executive-level placement, and more.

HealthCare Information Management, Inc

Walnut Creek, CA

Thomas Streeter, SVP of Product Solutions

Since 2000, HCIM has delivered robotic productivity solutions and consulting services to healthcare payers and managed care organizations

HealthCare Information Management, Inc