MedSynthea brings 9 coordinated AI agents together to automate the work between appointment scheduling and reimbursement. From eligibility verification to ERA/EOB payment posting, every step of the revenue cycle is orchestrated by specialist agents that reduce manual effort, surface risk earlier, and give your team a clearer path to clean claims and faster payments.
Healthcare revenue cycles have never been more expensive to manage manually. Rising denial rates, labor shortages, payer rule volatility, and the shift toward value-based reimbursement are forcing providers to rethink how they move a claim from registration to payment.
The traditional RCM model depends on fragmented handoffs between scheduling, eligibility, documentation, coding, claims, and payment posting. Each handoff introduces delay, data loss, and human error. Billing teams spend the majority of their time on repetitive administrative tasks rather than resolving the exceptions that actually require expert judgment.
MedSynthea was built to change that equation.
MedSynthea is an AI-powered healthcare revenue cycle management platform that automates claims, reduces denials, and accelerates reimbursements with 9 specialized AI agents working in parallel.
Unlike point solutions that address a single RCM stage, MedSynthea orchestrates the entire lifecycle from the moment an appointment is scheduled through final payment reconciliation. Each agent is purpose-built for a specific stage of the revenue cycle, and they communicate with each other to preserve context, flag risks, and eliminate the manual handoffs that slow traditional billing operations.
Supports appointment-related workflows and captures the operational context that affects the patient journey and downstream revenue cycle.
Runs real-time insurance eligibility verification and deep benefits analysis before patient encounters.
Handles clinical transcription and documentation, converting encounter audio into structured clinical notes.
Processes and structures clinical documentation for downstream coding and compliance review.
Performs automated medical coding (ICD-10 and CPT), applying payer-specific rules and compliance checks.
Runs denial risk prediction before claim submission, flagging potential issues based on payer rules and historical patterns.
Applies continuous learning from claim outcomes to improve accuracy and adapt to changing payer behaviors.
Manages autonomous outbound caller orchestration and claim follow-up workflows.
Handles ERA/EOB processing, payment posting, and financial reconciliation.
5–7%
5–7% across the provider network
70%
70% reduction in manual intervention
99%+
99%+ submission accuracy
10×
10× more claims per day with the same headcount
0%
0% PHI in system logs
100%
100% evidence traceability — every code and note linked to source
4.2×
4.2× faster payment cycles
Identify the RCM processes, data handoffs, review points, and exceptions that matter most to your organization.
Set appropriate operational rules, review logic, and ownership across the selected workflow stages.
Agents take on defined tasks while your team sees activity, decisions, and exceptions in a centralized workflow.
Use approved feedback, operational trends, and outcomes to refine workflows over time.
See agent activity, task status, and exceptions in a single operational view.
Keep people involved for sensitive, high-impact, or incomplete cases.
Preserve workflow history to support operational accountability and review.
Align review logic, ownership, and feedback loops with the way your team works.
Data is de-identified before any AI reasoning occurs, using a Zero-Trust Scrubber and 15-minute TTL encrypted Token Vault.
No protected health information appears in system logs at any point.
Every code and note links to source audio for an immutable, hallucination-free audit trail. Specialist agents follow a strict rule of evidence, linking every clinical note and billing code to source audio segments.
MedSynthea acts as a compliant middleware layer, using SMART on FHIR to write approved documentation and codes directly into your existing EHR.
9 Core Agents covering real-time eligibility verification, deep benefits analysis, automated medical coding (ICD-10 & CPT), claims validation based on payer rules, denial risk prediction, clinical transcription & documentation, and autonomous outbound caller orchestration.
+5 Intelligence Agents adding denial root cause identification, automated appeals management, payment posting automation (ERA/EOB), financial reconciliation and validation, and patient billing statement generation.
+4 Automation Agents adding prior authorization automation, underpayment detection and validation, real-time payer policy tracking, provider credentialing automation, and contractual variance detection.
+3 Analytics Agents adding advanced RCM performance dashboards, AI-driven revenue forecasting, real-time compliance monitoring, predictive patient propensity to pay, and operational bottleneck identification.
“MedSynthea is a fully autonomous AI platform that streamlines the entire RCM cycle—from initial eligibility to final payment. By deploying intelligent, end-to-end automation, it drastically reduces operational costs, accelerates clinical workflows, and proactively minimizes claim denials.”
See what autonomous revenue-cycle operations can look like in your environment.