Why Synthesis HealthSoft

Cost cutting’ & Quality service

Why Synthesis HealthSoft?

Our experienced team in the US Healthcare is well positioned to manage these challenges from offshore. We have helped clients cut operating costs by 30-40%. Our processes are HIPAA and OIG compliant.

Synthcare is a Synthesis HealthSoft Payer Product with 3 Levels
  • Basic

    Member Enrollment (Online, Paper and Telephonic mode)

  • Intermediate

    BEQ and MARX Generation, Document Management System

  • High End

    Premium Billing Reconciliation and Collections

with 3 Levels

Synthcare is a Synthesis HealthSoft Payer Product

ModulesBasicIntermediateHigh End
Member Management

  • Member Enrollment (Online, Paper and Telephonic mode)

  • Member Maintenance

  • Agent and Agency Maintenance

  • BEQ and MARX Generation

  • DTRR Workings

  • ID card and Letter Generation

  • COB Maintenance

  • LIS and LEP


  • Peak Period Overflow support

  • COBRA Support

  • Premium Billing Reconciliation and Collections

  • Payment Reconciliation

  • End of Year migration workings (SAR, SAE, ANOC, Rollover, etc…)

Provider Management

  • Provider Configuration and Maintenance

  • Vendor Management

  • Provider Directory
  • 1099 Process (W9)

  • Comparison with

  • Black list providers

  • Contract Analysis for contract negotiations

Claims Processing and Adjudication Services

  • Mail Room Functions

  • Claims Entry both Paper/EDI -HCFA, UB, Dental and Member Reimbursement

  • Claim Processing – HCFA/UB/Dental

  • Claims G&A

  • Member OOP Maintenance

  • COB Claims Processing

  • Backlog Conversion and Reduction Support

  • Claims Re-pricing

  • Peak Period Overflow support

  • Adjustment and Refunds

  • EOB Generation

  • Pre-audit Review

  • Post Recovery Audit

  • DRG Validation

  • Payment Integrity/Validation

  • Bundling Analysis

  • High Dollar Review

  • Case Rate Analysis

  • Retro Enrollment and Disenrollment Analysis

  • Duplicate Analysis

  • Fraud and Abuse Analysis

Utilization Management

  • Data Capture

  • Population Health Management by funneling process


  • Coding Rules Configuration

  • Fee Schedule Management

  • Medicare and Medicaid Rules Configuration

  • Provider Contract Configuration

  • Benefit Configuration

EDI Transactions

  • All EDI Sets Generation and Acceptance – 4010, 5010 and Proprietary Formats


  • Medicare Claim Processing Rules

  • Statutory Reports

  • Provider Documentation

  • Professional and Facility Coding

  • Consultation

Medicare Accountable Care Organization (ACO)

  • Medicare Accountable Care Organization (ACO) portal for board of ACO.

IT Services

  • Module Development

  • Portal Development

  • Web Services

  • Document Management System

  • Unclean Claim Workflow

  • Auto Adjudication

  • Integrated Work flow Management

  • TPA Handshakes

  • Automated placing and pickup of files

  • Cloud based solutions

  • Vendor specific customizations