Synthcare is in-house proprietary software with Rule Engine for Medicare, Medicaid and Commercial which can be used for various states in US with minor tweaks. Capable of handling the following healthcare programs:
Modern self-service
Synthcare is a self-serve enterprise web application at its best, with frequent updates and real-time administrative communication; it raises user engagement to new heights.
Synthesis is divided into four unique portals, allowing any audience to use any device to access the functions they require.
1. Members
2. Employers
3. Providers
4. Agents / Brokers
The Synthcare Member
The Member experience is the leading employee self-service solution. We can guarantee that your members will remain engaged thanks to real-time administrative processing and an intuitive, user-friendly design. Announcements, Requests, Accumulators, and Claims are among the core functions provided by the Member Portal. The combination of features available on Synthcare enables a member to meet almost any administrative requirement without having to contact the administrator directly. As a result, the member is more engaged and informed.
Members can request demographic and coverage updates without contacting customer service or HR. Self-service requests are sent to synthesis in real time, allowing the administrator to accept or reject them. Address changes, enrolment updates, adding family members and all examples of self-service requests that a user can make.
Members can use the Member Portal to view or print Virtual ID Card and EOBs, Your members will never be left in the dark about their plan information again.
Members can view accumulator information based on which plans they are enrolled in. Accumulator information can be viewed by member, plan, and accumulator period, and includes deductible and out-of-pocket totals. Members receive detailed accumulator information, such as actual and remaining amounts.
Communicate with your members using the simple-to-use Message Centre provided. Members can communicate directly with their plan administrator, obviating the need for HR or customer service phone calls. Members can check the progress of their submitted self-service requests, as well as administrator responses, thereby expediting turnaround.
This section of the Member Portal summarizes the member's claims. Claims are processed in several stages, and the member is informed of the status of each claim. The grid enables members to sort and arrange claim data without re-querying the backend. Expanding a claim enables the member to view the claim's details, including specific services and the amount billed, authorized, member responsibility, not covered, and paid. Additionally, the member can access the EOB supplied by the administrator for each claim processed via the system.
With this, member can view available different plan benefit packages to choose and get enrolled by themselves directly without a third-party dependency. Once enrolled, the synthcare portal enables several customized features for member to manage their eligibility through member portal. Synthcare’s online enrollment portal designed to provide comprehensive self-services support to their members hassle-free. Comes with Built-in feature for health plans, agents to integrate this portal with their owned websites.
Permit your Providers to conduct enrolment searches for patients and enrollees in their networks. The provider is provided with information regarding eligibility and enrolments, as well as a live accumulator snapshot. Authorization requests for certain required services can be ordered through this portal for expedite approvals since this portal have built-in option to integrate with the real—time claim processing application.
The SYNTHCARE Agent/Broker experience includes extensive self-service capabilities that are tailored to the unique requirements of this role. Self-enrolling an agent/agency by furnishing basic necessary details and upon getting administrative approval it enables features such as to enroll a member to health plan, create and send dedicated online enrollment links to members and many more.
Access complete information
Employers can access complete information about their plan population through the SYNTHCARE Employer experience. SYNTHCARE provides precise census and claim statistics that may be sliced and diced as needed by the employer. Representatives who utilise SYNTHCARE benefit from a differentiated user experience that enables rapid consumption of pertinent data. Representatives can assess members' interaction with the site and their participation in the strategy. The combined experience results in a genuinely formidable tool for plan management.
Powerful employee
Access member information for your groups and divisions quickly and easily, including enrolment history, accumulator details, and family census data. Directly from the census, members can update their information and request or print new ID cards. Export census lists and individual member reports directly to Microsoft Excel using the Employer Portal's reporting capabilities.
Employer Portal users can easily make self-service requests on behalf of their members, such as adding new members or coverage, or updating demographic information. The Message Centre, which displays the current status of all self-service requests, allows you to keep track of the status of your self-service requests.
The Employer Portal is brimming with census and claims insights: charts and graphs detailing your business's plan, claim, and demographic breakdowns. Utilize insights such as "Paid Claims Turnaround," "Benefits Average Billed," and "Census by Plan Type" to keep an eye on your business.
The SYNTHCARE Provider experience gives providers access to claims and eligibility data through a rich and evolving user experience that aims to make providers want to use it more. Providers who use SYNTHCARE save money because they don't have to write or talk as much. The Provider Portal allows a registered user to do things on their own, like check eligibility information and check the status of a claim. They can also make real-time requests like preauthorization’s and claims.
Providers have access to EOBs, provider remittance, and provider claim & check reports.
Permit your Providers to conduct enrolment searches for patients and enrolees in their networks. The provider is provided with information regarding eligibility and enrolments, , as well as a live accumulator snapshot.
The Provider Portal features an interactive grid that enables your providers to search for any claims they have billed. The SYNTHCARE interactive grid enables sorting and grouping of the resulting claims list while still displaying all necessary information in an easy-to-read format.
SYNTHCARE
The SYNTHCARE Agent/Broker experience includes extensive self-service capabilities that are tailored to the unique requirements of this role.
The Census provides statistical data on the broker's member base. Members can be located using their Group, their name, or other demographic information. Member information is easily accessible and includes enrolment history, family information, and detailed claims information.
This feature displays announcements made by various entities. The administrator may broadcast an announcement. The user is informed visually of the source of the announcement, as well as the announcement's importance. Agents/Brokers can quickly access the details of an announcement by clicking on it.