A fully digital claims lifecycle — from submission to settlement — with transparent tracking, automated adjudication, and sub-5-day payment cycles.
The Synora claims workflow is designed for speed, accuracy, and transparency. Every stakeholder — provider, payer, member — has real-time visibility at each stage.
Provider delivers care. Member eligibility verified at point of care via API or USSD.
Provider submits claim via portal, mobile app, or API. ICD-10 + CPT coding required.
Automated checks: eligibility, coverage limits, documentation completeness, duplicate detection.
AI-assisted adjudication with clinical analyst review for complex or high-value claims.
Direct bank transfer to provider account. Remittance advice sent via email and portal.
Synora's fraud detection engine runs on every claim submission, cross-referencing clinical patterns, billing codes, and provider behavior to flag anomalies before payment.
Rejected claims can be appealed through a structured, documented process with defined timelines and independent clinical review.
Provider receives rejection with specific reason codes and supporting documentation requirements within 24 hours.
Provider submits appeal with additional documentation via the portal within 30 days of rejection notice.
A clinical reviewer independent of the original adjudicator reviews all appeal submissions for fairness.
Final decision communicated within 7 days. Successful appeals are paid within the standard 5-day cycle.