A complete healthcare payer service and solution covering Pre Adjudication Services, Adjudication of claims, Post Adjudication service, Data management for Medicare reporting, Medicaid and Commercial HMOs

• Pre-Adjudication process covers - Data Entry – HCFA & UB claims, Provider Credentialing & Contracting, Member data Management, Provider Data Management, Claims Adjudication – UB & HCFA
• Adjudication - Resolution of Pending claims, Generation of Explanation of Benefits (EOB)
• Post Adjudication Service - Explanation of Benefit – Printing, HCC and RAF coding Support, Support UM requirement, Customer Service – Member, Provider and Agent, Appeal and Grievance
• Value added Services - SOB audit, Reimbursement Audit, DRG coding audit etc.

In addition Synthesis HealthSoft also provides TPA services around managing COBRA, ERISA, Flexible Spending Accounts