Efficient Claims Management for Smarter Healthcare Payer Operations
we provide advanced Claims Management solutions to help healthcare payers streamline their claims lifecycle—from submission to adjudication and payment. Our platform automates complex workflows, reduces manual errors, and accelerates claims processing time. With support for EDI formats, real-time tracking, and integrated validation rules, we ensure claims are processed accurately and compliantly. Whether you're managing commercial, Medicaid, or Medicare claims, our solutions enhance operational efficiency, reduce denials, and improve provider satisfaction. We empower you to stay compliant with evolving regulations while ensuring cost-effective, error-free claim settlements.
Our end-to-end claims management services include eligibility verification, claims intake, data validation, automated adjudication, and appeals handling. We leverage robust analytics and AI-driven insights to detect anomalies, reduce fraud, and optimize claims performance. Integration with your existing payer systems ensures a seamless experience across multiple touchpoints. With dashboards, reporting tools, and audit trails, decision-makers gain full visibility into the claims ecosystem. At Santric Technologies, we bring technology and compliance together to transform healthcare payer operations—delivering faster reimbursements, lower overheads, and improved member and provider satisfaction.
Our Core Coding and Health Information Management (HIM) Services
Industries We Serve
We verify member eligibility and capture claims through secure EDI and digital intake channels. Built-in validation rules ensure accurate data entry while reducing rework and manual intervention at the earliest stage.
Each claim is automatically checked against payer policies, coding standards, and regulatory requirements. Intelligent edits identify missing data, inconsistencies, and duplicate claims to prevent downstream denials.
Our rules-driven adjudication engine applies benefit plans, contract terms, and reimbursement logic in real time. This accelerates claim decisions while maintaining accuracy, transparency, and compliance.
Denied or pended claims are routed for root-cause analysis and timely resolution. We manage appeals, corrections, and provider communication to maximize claim recovery and reduce turnaround time.
Advanced dashboards and AI-driven insights provide visibility into claim volumes, denial trends, turnaround times, and cost drivers. Continuous optimization helps improve payer performance, reduce fraud, and enhance provider satisfaction.
