An innovator in healthcare technology, SANTECHTURE offers solutions that intelligently manage and automate insurance revenue operations supporting lower denial rates and lower costs for healthcare providers across the full spectrum of the Revenue Cycle Management (RCM).
THYNK is a powerful business rules knowledgebase applied to detect medical and insurers policy violations in real time at each touch point of the patient’s journey. Over 1 million payer specific rules and more than 2 million medical guidelines, based on local and international best practices, enable THYNK to guide administrative and medical staff on content requiring correction to achieve a coherent clean claim.
Whether used as a fully integrated solution or a standalone
claim scrubber solution, THYNK brings immediate tangible
financial value as a cohesive, effective, and up-to-date
managed rules content to support providers to:
THYNK manages millions of knowledgebase rules that are updated by a board of clinical and insurance experts. Rules are continuously reviewed and adapted to changing market, regulations or payer claims adjudication practice.
Our technology uses input data feeds such as mandatory and optional data elements, members insurance details, diagnoses and medical activities as well as patient demographics and history to detect a wide range of potential issues that may exist in the medical claim.
THYNK has the capability to process a single claim or a large batch of claims in real time and reports violated rules categorized according to error severity and risk of denial.
Medical Necessity: Rules that review all claim medical activities and identity services that may be subject to lack of medical necessity support on evidence-based clinical standards of care.
Billing: Enforcing regulator and contractual billing protocols including verification of medical services fees, mandatory lab results or supporting notes, patient share such as deductible and co-payment, follow-up visits, per-diem, and Diagnosis Related Grouper (DRG) rules.
Payer: Adjudication logic and patterns related to the specific insurance practice including patient policy or network rules, medical reviews, card formats, and policy benefits linked to claimed services.
General: Custom rules that can accommodate any provider-specific rules related to business practice or payer-specific agreed contractual terms.
Workflow: Rules related to auto-routing of claims based on defined business workflows related to quality audits or authority matrix for review and approval of complex cases or high value claims.