🔄 Claim Submission

ZyncFlo

The agentic AI-enabled unified claim submission engine connecting every provider to every payer network with intelligent pre-submission validation, automated routing, and real-time status tracking.

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🔄 Multi-Payer Routing 🤖 AI Validation ✅ NHCX Connected
ZyncFlo Agent · Claim Submission
// Provider submits OPD claim → zyncflo.submit("CLM-PRV-44821") provider: Apollo Clinic, Gurugram payer: Star Health Insurance amount: ₹3,200   // AI pre-submission validation → zyncflo.validate() eligibility: verified ✓ codes_check: ICD-10 + CPT valid ✓ duplicate_check: unique ✓ rejection_risk: 0.03 low   // Routed via NHCX → zyncflo.route_nhcx() channel: NHCX gateway ack_id: NHCX-ACK-9910024 status: submitted ✓ elapsed: 2.1s
98.4%First-pass claim acceptance rate
2.1sAverage submission time per claim
50+Payer networks connected
ZeroManual submission effort for providers
Integrated with leading HIMS systems of India
Features

Every claim, every payer,
submitted by AI

🔄

Multi-Payer Claim Routing

Single API connection routes claims to any payer network NHCX-connected insurers, TPAs, government schemes, and corporate self-insured payers with format transformation handled automatically.

🤖

AI Pre-Submission Validation

Agentic AI checks every claim before submission: eligibility, code validity, duplicate detection, and rejection-risk scoring. Errors fixed before they reach the payer not after.

📡

Real-Time Status Tracking

Live claim status dashboard from submission through adjudication to payment. Every state change pushed to the provider's system via webhook no polling, no manual follow-up.

🏥

NHCX & ABDM Integration

Native NHCX gateway connectivity for all NHA-mandated claim flows. Supports ABDM-linked claim submission with ABHA-verified patient identity fully compliant out of the box.

🛡️

Rejection Prevention Engine

ML model trained on millions of Indian health claims identifies the exact fix for each error type reducing rework, re-submission cycles, and revenue leakage for providers.

📊

Provider Revenue Analytics

Full visibility into claim volumes, turnaround times, rejection rates by payer, and outstanding receivables giving revenue cycle teams the data to improve performance continuously.

How It Works

From clinical encounter
to settled claim

ZyncFlo handles the full claim submission lifecycle from the moment a provider creates a claim to the moment payment lands in their account.

1
Claim Created at Point of Care

Provider's HMS or billing system sends the claim to ZyncFlo via API. No manual data entry the agentic layer receives, enriches, and structures the claim automatically.

2
AI Validates Before Submission

Pre-submission AI checks eligibility, clinical codes, supporting documents, and duplicate status. Rejection risk is scored and providers are alerted to fix issues instantly.

3
Routed to the Right Payer

Clean claims are automatically routed via NHCX, direct payer APIs, or TPA portals with format transformation handled by ZyncFlo. Providers touch nothing.

4
Status Tracked to Settlement

Real-time status updates flow back to the provider's system at every stage. Payment advice received and matched automatically against submitted claims.

Claim submission tracking dashboard
Impact

Less rejection, faster payment,
zero manual work

98.4%
First-pass acceptance rate industry average is 85%
60%
Reduction in claim rejection and re-submission cycles
T+20
Average settlement cycle vs T+45 with manual submission

Connects providers to
every payer automatically

Book a demo and see how ZyncFlo connects to your existing HMS and routes claims to your payer network in under 48 hours.

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