Enterprise Software Solution
for Healthcare Insurance

SynthCare

The application has Integrated Document Management system, Integrated Business Process Management Tool to manage work allocation and quality management on transaction processing, Integrated e-learning module with capability to interface 3rd party vendor. This enterprise wide application is designed to operate in a multi location and multi user environment.

Medicare

Complete Member, Provider Management and Claims Processing. Adherence to CMS process flow for Medicare.

Medicaid

Member, Provider Management and Claim Processing. Adherence to AHCA for Medicaid through State Agencies

Commercial

Complete Member management system starts from enrollment till disenrollment includes Break in period and Reenrollment.

Add-On Services

Web Portals, Member Service, Utilization Management, Agent Commission, Premium Billing and Reports

End-To-End Payer System


Member Management

  • Enrollment (Manual/Electronic)
  • Enrollment (834 - D,A,MM, ME) & Reconciliation
  • Other Insurance & New born activation
  • TPL (Third Party Liability), Causality Member Details
  • CMS (MBD Verification, BEQ, MARX, TRR, BCSSR)
  • Member Request (Demographic/Plan change, ID Card) & Audit Trail
  • Letters and Exhibits & Premium Billing
  • Eligibility Sharing/Verification (EDI-5010 Standard - 834, 270-271)
  • EOY Activities (ANOC, AMK, NMK, PBP Roll over etc.)

Provider Management

Provider group management start from Credentialing till contract loading.

  • NPI Registry based Unified providers
  • Grouping of providers under networks, panels etc.
  • Credentialing
  • W9 forms
  • 1099 report generation
  • Contract loading
  • IRS levy

Claim Processing

  • Paper/EDI 837 - HCFA & UB Claims
  • Claim Entry Audit
  • Adjudication Integrated with Benefits, Eligibility, Provider Contract and Authorization
  • Dedicated Medicare/Medicaid Rule engine with complete CMS/State edits
  • Claims work allocation and High$ claims review
  • Electronic Claim Status Enquiry (EDI - 276 & 277)
  • Offset adjustments, Void and Reissue of Checks

Add-On Services

  • Utilization Management -Population Management - Initial Assessment for Case Management – Disease Management and Complext Case Management.
  • Customer Service - Ticketing System - Provider and Member tickets - Allocation - Ticket History
  • Agency and Agent System - Training Integration (Cyberworks) - NIPR Verification & Appointment - Agent Hierarchy
  • Automatic Collection System - Payment recovery 1st Letter - 2nd Letter as Per CMS guidelines for Par/Non par providers - Payment Posting - Auto offset
  • Grievance and Appeal
  • Reports - Dashboard & Standard Medicare and ACHA Reports

Platform and System Requirements

Development Environment

MS-Visual Studio 2012 & MS-SQL Server 2016
.NET Framework 4.5

Hosting Options

Deploy and configure on our server/cloud

Hosting System Requirements

Windows Server 2012 and above
SQL Server 2016 Express/Standard Edition


We have developed an Enterprise wide claims processing application in .Net environment. Application covers all functions required for a Healthcare Insurance company.

Get In Touch

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India

Address
Synthesis HealthSoft Services and Solutions LLP
#141 IT Highway, Prakash Towers, Kottivakkam, Chennai 600041

Phone
+91-44-2454 5523 / 24 / 27

Email
rajiv@synthesis.care

United States

Address
1620 Gateway Blvd,
Suite 102 Murfreesboro
TN 37129

Phone
866-650-9414

Email
rajiv@synthesis.care