At Synthesis HealthSoft, we deliver a robust, scalable, and compliant claims management ecosystem designed to handle the complexity of modern healthcare payers. Our combines advanced adjudication, intelligent re-pricing, and real-time validation to ensure every claim is processed with accuracy, speed, and compliance.
We process millions of transactions each year through a secure and proven deep expertise in state and county-level US regulations, ensuring full compliance and precise charge control across all specialties.
End-to-End Claims Lifecycle Management
From intake to payment and post-payment audit — we support every stage of the claims lifecycle with precision and speed.
Advanced Adjudication & Re-Pricing Intelligence
Our adjudication engine embeds critical validations at every stage, going far beyond standard processing.
A powerful multi-layer rules engine combining Medicare standards, plan-specific configurations, and user-defined edits for maximum accuracy.
Medicare rules & compliance standards
Plan-specific configurations & logic
User-defined edits & custom rules
Duplicate claims detection
Third Party Liability (TFL) checks
Authorization & eligibility validation
Real-time eligibility checks at the point of claim intake, ensuring only valid claims proceed to adjudication.
Automated contract validation and pricing accuracy checks against current fee schedules and network agreements.
Hundreds of automated checks — eligibility, authorization, duplicates, TFL, and plan-specific rules running simultaneously.
Service Details
Millions of transactions flow through our platform annually — built for enterprise-level payer operations with unmatched reliability.
High accuracy & rapid turnaround times
Secure and reliable data architecture
State & county-specific compliance expertise across the US
Customizable charge control mechanisms across specialties
Built-in workflow automation across all modules ensures seamless integration and operational efficiency at every step.
Soft edits for real-time data validation
High-dollar claim review based on configurable thresholds
Authorization & benefits linkage to claims
MOOP tracking including family limits
Integration with Member, Provider & Utilization Management
Stay informed with actionable insights via our comprehensive reporting module designed for decision-ready analytics.
Daily reports on No Pay, Underpay & Denials
Priority-driven resolution workflows
Decision-ready analytics to improve financial outcomes
Real-time dashboards for operational visibility
A Delivery Model Designed Around Your Needs
Choose the delivery framework that best fits your organization’s size, complexity, and operational goals.
Expert claims specialists embedded into your operations — managing adjudication, appeals, and reporting using your existing systems.
Certified claims & adjudication experts
Works within your existing platform
Rapid onboarding & scalable headcount
The expertise and infrastructure that sets us apart in claims management
Proven high auto-adjudication rates
Deep Medicare & Commercial expertise
Fully configurable and scalable platform
Strong compliance and audit capabilities
Faster processing with reduced operational cost
End-to-end integration across payer ecosystem
Partner with Synthesis HealthSoft to achieve higher accuracy, faster payments, and complete compliance in your claims lifecycle.