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

Modules	Basic	Intermediate	High 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 COMPRPT and MMR 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
Configuration			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
Consultation			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