Case Study: SynerMed reduces fraudulent claims and grows TPA business with PCG Software's Virtual Examiner

SynerMed - Customer Case Study

SynerMed, a Los Angeles-based technology and services provider for healthcare organizations, needed a better way to identify and deny fraudulent, abusive, and wasteful claims that manual claims processing could miss. To address this challenge, SynerMed turned to PCG Software and its Virtual Examiner FAW-detection software to help auto-adjudicate claims and flag discrepancies and medically impossible codes.

PCG Software implemented Virtual Examiner for SynerMed’s non-TPA business lines in 2003 and later expanded it to self-funded clients in 2006. The system automatically denies claims that hit internal edits, while SynerMed uses the resulting data to correct provider billing practices and, when necessary, support removing repeat offenders from the network. The case study does not provide specific financial metrics, but it reports that the solution helped SynerMed strengthen cost control and grow its TPA business with a competitive advantage.

SynerMed