Post-service
>
Claims and Adjudication

Improved turnaround time. Reduced costs.

With 99%+ accuracy, a turnaround time of 24 hrs, and gap identification, we help in timely payments and reduced costs.

Up to
99
%+
payment accuracy
24
hr
TAT
99
%+
adjudication quality
Up to
99
%+
payment accuracy
24
hr
TAT
99
%+
adjudication quality
Up to
99
%+
payment accuracy
24
hr
TAT
99
%+
adjudication quality
Up to
99
%+
payment accuracy
24
hr
TAT
99
%+
adjudication quality
What we offer

Claims and Adjudication

Claims adjudication is the process of reviewing claims received and either settling or reducing, or denying them after due analysis.

AI-powered Claims Processing

Synova offers a state-of-the-art claims processing solution that significantly enhances efficiency, accuracy, and cost-effectiveness. In addition, this solution also brings automation and efficiency, adjudication accuracy and compliance, and fraud detection.

helps with

  • Enhancing efficiency
  • Improving adjudication accuracy
  • Detecting fraud

CMS and State Regulatory Compliance

Synova offers claims processing services ensuring adherence to CMS and state regulations. By prioritizing CMS and state regulatory compliance in the claims and adjudication process, we help you mitigate compliance risks, enhance revenue cycle integrity, and improve reimbursement accuracy.

helps with

  • Mitigating compliance risks
  • Enhancing revenue cycle integrity
  • Improving reimbursement accuracy

Detection of False Claims

Synova ensures that set procedures and checks are followed, ensuring that no false medical claims are approved for the financial benefit of any individual.

helps with

  • Ensuring procedural compliance
  • Preventing financial fraud
  • Upholding ethical standards

Find what’s Right for you

Discover how Synova can unlock value through our customized solutions across all stages of your healthcare journey. From optimizing operations to enhancing patient care, we're here to support your journey toward excellence in healthcare delivery.

Challenges We Solve

Choosing Claims and Adjudication

Claims Rejections and Denials

High rates of claims rejections and denials result in revenue loss, increased administrative costs, and delayed reimbursement, leading to delayed turnaround times and poor customer satisfaction.

High Operational Cost

Inaccurate and incomplete claims need manual interventions and rework by payers.

Data Integration and Interoperability

Limited interoperability between different systems, data silos, and manual data entry lead to data integration challenges and inefficiencies in claims processing. Synova implements integrated healthcare IT systems, utilizing electronic health record (EHR) integration for seamless data exchange.

Measurable Impact

Up to
99
%
payment accuracy
55
+
years of consolidated experience
99
%+
adjudication quality
Customized Solutions

Designed for your Requirements

Our service solutions streamline operations, enhance patient engagement, and integrate advanced clinical support technologies, tailored to meet your specific needs with efficiency and excellence.

Timely Disbursal

Synova ensures that the correct claim amount is disbursed timely and accurately. The team also ensures billing and coding compliance, documentation integrity, payer contracting and reimbursement compliance, and a clean claim submission process.

Enhanced Operational Efficiency

Streamlined claims processing workflows, automation of routine tasks, and efficient adjudication practices optimize operational efficiency, reduce manual errors, and increase productivity.

Faster Revenue Recognition

Prompt claims adjudication and accurate payment posting lead to faster revenue recognition, financial reporting accuracy, and visibility into revenue streams. This supports informed decision-making, budgeting, and financial planning.

Data Accuracy

Synova checks data accuracy using an AI-powered claims adjudication engine. This maintains the integrity of data collected to reduce the chances of claim denials.

how it works

How Synova Is Integrated with your Business

Synova integrates seamlessly into business operations by deploying advanced technologies and specialized expertise in healthcare operations management. This integration optimizes processes, enhances efficiency, and ensures compliance, supporting sustainable growth and improved patient care outcomes.

01

Claims Submission

The process begins with healthcare providers submitting claims to insurance companies, government payers (such as Medicare or Medicaid), or other third-party payers. Claims can be submitted electronically using standardized formats or through paper submissions.

02

AI-powered Claims Processing

Upon receiving a claim, our automated claims processing system reviews the claim for accuracy, completeness, and compliance with coding guidelines, medical necessity requirements, and payer policies. This step involves initial claims scrubbing, which checks for errors, missing information, duplicate claims, and potential fraud.

03

AI-assisted Claims Adjudication

After claims processing, we evaluate the claim against the patient's insurance coverage, benefits, and contract terms with the payer. The claim is reviewed for eligibility, coverage determination, medical necessity, and reimbursement calculation based on fee schedules or negotiated rates.

04

Payment or Denial

Based on the adjudication outcome, we either approve the claim for payment or deny the claim. If approved, we issue payment to the healthcare provider.

frequently asked questions

All your Doubts Resolved

What is claims adjudication?

Claims adjudication is the process by which insurance companies review and determine the validity, eligibility, and payment amount for a submitted healthcare claim.

What are common reasons for claim denials?

Common reasons include:

  • Incomplete or incorrect information: Errors in patient details, coding, or claim forms.
  • Lack of coverage: Services not covered by the patient’s insurance plan.
  • Medical necessity: Services deemed not medically necessary.
  • Authorization issues: Missing or incorrect pre-authorizations.
  • Timely filing: Claims submitted after the insurer’s deadline.
What is the difference between a clean claim and a dirty claim?

A clean claim is complete, accurate, and has no errors, allowing for prompt processing and payment. A dirty claim has errors or missing information, which can delay processing and require further investigation or correction.

How can providers reduce claim denials?

Providers can reduce denials by:

  • Ensuring accurate data entry: Double-checking patient and insurance information.
  • Proper coding: Using correct and up-to-date medical codes.
  • Obtaining necessary authorizations: Securing pre-approvals when required.
  • Timely submission: Submitting claims within the insurer’s timeframe.
  • Regular training: Keeping billing staff updated on coding guidelines and payer requirements.
What is an Explanation of Benefits (EOB)?

An Explanation of Benefits (EOB) is a statement from the insurance company explaining what medical treatments and services were covered, the amount paid, and what the patient owes.

Your Process, Our Technology

Building a Partnership grounded in trust and transparency.

When we build solutions with healthcare organizations like yours, it significantly reduces development and adoption times. We work as partners to solve problems and unlock tangible value.

Accelerated Outcomes
Partnering with Synova reduces development and adoption times, expediting the delivery of efficient revenue cycle solutions.
Value-driven Collaboration
By combining healthcare organizations’ patient-focused experience with Synova’s expertise, our partnership unlocks tangible value and fosters innovation.
Compliance Assurance
Collaborating with Synova ensures solutions are developed to meet industry standards and regulations, fostering trust and delivering high-quality, compliant outcomes.

Bring a change to your Healthcare Operations

A partnership with Synova gives you an inherent:

Adherence towards federal, state, and organizational compliances, as well as safeguarding patient data.

Sense of ownership and commitment towards providing value.

Focus on speed, accuracy, efficiency, and optimal outcomes.

Sense of security and transparency through periodic reporting and actionable insights.

Connect with our experts for a quick analysis and possibilities.

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