Virtual Examiner (VE) is a complete cost containment and financial recovery system. The VE claims scrubber reviews Health Care Financing Administration (HCFA) 1500 claims and identifies claims that are improperly coded or clinically inconsistent. With VE, SynerMed applies over 250,000 edits to each claim. Features of the service include:

• Daily claims and authorization production monitoring
  
  
• Monetary savings by identifying retro-deletes from eligibility, a better way to reconcile eligibility to capitation (3 -15 percent per check run savings)
  
  
• Software identifies denials and pending claims based on coding infractions:
  
  
  • Unbundling
    
    
  • Upcoding
    
    
  • Standards of medical practice
    
    
  • With and without services
    
    
  • Mutually exclusive services
    
    
  • Most extensive procedure
    
    
  • Laboratory panels
    
    
  • Separate procedures
    
    
  • Sequential procedures
  
  
• Third-Party Liability (TPL) and stop-loss identification and recovery
  
  
• System catches duplications by provider and by member (Most systems only catch one or the other)

A proprietary workflow program, EZ-Claims is an electronic claims interface that gives SynerMed’s contracted providers a more efficient method for claims and encounter submission, as well as the ability to receive payment faster. To boost productivity, the system organizes claims from oldest to newest, arranges priority and ensures timely payment. SynerMed has the ability to process HCFA 1500 or UB-92 claims electronically or manually. The system processes more than 45,000 claims a month from over 8,000 different providers.

The EZ-Auth system features authorization workflow to provide timely applications that foster better communications between SynerMed, its customers and their members. This technology allows SynerMed customers to enjoy virtually instant authorization turnaround times. The basis of this technology is a multi-port fax server that allows SynerMed to receive and send authorizations without having to print the authorization to paper. The authorization request is received via fax and converted to email. Once the authorization is converted, the system automatically routes the authorization to the proper SynerMed employee for processing. Upon processing the authorization, all records are stored in an image repository so they may be retrieved via a secured internet connection or internally. After the authorization is processed, all decisions are then automatically faxed back to the requesting and rendering provider. The system will continue to send the fax until it reaches the doctor’s office, so authorization backlog is a thing of the past.

The Virtual Auth Tech™ interface is used by coordinators to ensure authorizations are coded correctly on the front-end.

SynerMedConnect™, is the company’s online Electronic Medical Management (EMM) system, which is poised to address the future of health care transactions. Unlike Electronic Medical Records (EMRs), an EMM is a robust system that can cut costs and save time by reducing administration and allowing health administrators and individual physicians to access, store and process information instantaneously. SynerMedConnect offers a diverse menu of functions including authorizations, claims submissions and eligibility verification services. The system also has a unique web-based business application that allows SynerMed’s medical staff to communicate directly with patient’s physicians, increasing the efficiency of patient care. In addition, SynerMedConnect caters to the large number of medical practices that haven’t been able to purchase expensive EMR systems. For these customers, a fax machine can be used to enter data into the SynerMedConnect network.

SynerMed’s E-consult pilot program enables primary care physicians to consult electronically with specialists throughout Los Angeles. E-consults are at the cutting-edge of health care delivery, increasing direct communication between physicians and helping to eliminate unnecessary office visits. The result is efficient care, coordinated according to the patient’s individual case. In addition, e-consult programs have proven to reduce clinic wait times by triaging urgent and non-urgent issues before a patient even visits the specialist’s office.