AI claim scrubber for primary care billing
Syntra reviews E/M documentation for MDM, chronic-condition complexity, and separately identifiable procedures before primary-care claims go out. Syntra is an AI claim and chart scrubber that reviews primary care documentation against the claim before submission, so billing teams prevent denials instead of working them.
Example capture
99214 · Office visit, established patient, moderate MDM
Assessment documents moderate-complexity MDM across multiple chronic conditions with prescription management. Supports reporting 99214 when medical decision making meets moderate.
What causes primary care claim denials?
Most primary care denials trace back to the chart: a service documented but not coded, a code the note does not support, or a modifier that is missing. These are the patterns Syntra checks on every primary care encounter before submission:
- E/M level that does not match documented medical decision making
- Preventive and problem-oriented visits on the same day billed without modifier -25
- Chronic care management and annual wellness visit requirements not met in the note
Which primary care modifiers and edits does Syntra check?
Syntra applies NCCI (CCI) edits, MUEs, and payer rules, then confirms each modifier is supported by the documentation rather than added to get past an edit. Common primary care modifiers it validates:
- -25 on problem E/M with preventive visits
- -33 for preventive services
- G2211 add-on where longitudinal care is documented
E/M leveling under the 2021 and 2023 guidelines is based on MDM or time, which only the note can support.
Those checks follow public payer rules, including CMS National Correct Coding Initiative (NCCI) edits and Medicare Coverage Database (LCDs and articles). Syntra applies the rule to the note, which a claim-only edit cannot see.
How is this different from primary care billing software or a clearinghouse scrubber?
Billing software, practice-management systems, and clearinghouses scrub the claim after it is built: required fields, code pairs, and payer edits. They usually cannot see the clinical note. Syntra reasons on the note and the claim together, the way an experienced primary care coder would, which is how it finds undercoding and compliance risk that claim-level rules pass through. It sits on top of your existing revenue cycle management (RCM) stack rather than replacing it.
Read more on how Syntra differs from EHR scrub rules and clearinghouse claim scrubbers.
Primary Care claim scrubbing by EHR
Primary Care claim scrubber FAQs
- What is the best claim scrubber for primary care practices?
- The best primary care claim scrubber reads the chart, not only the claim. Syntra is an AI claim and chart scrubber that compares primary care documentation to the codes, modifiers, and payer rules before submission, so missed revenue and denial risk are caught while the encounter can still be corrected.
- How does Syntra reduce primary care claim denials?
- Syntra checks every encounter for the denial drivers common in primary care, including NCCI bundling, missing or incorrect modifiers, medical necessity, and global-period conflicts. It flags issues before the claim leaves the practice, which raises the clean claim rate instead of working denials after the fact.
- Does Syntra replace my primary care billing software or EHR?
- No. Syntra sits on top of your existing EHR, practice-management system, and clearinghouse. It adds chart-level pre-bill review to the revenue cycle (RCM) stack you already run.
- Which EHRs does Syntra support for primary care?
- Syntra integrates with Epic, Cerner, NextGen, Nextech, SIS, iMedicWare, athenahealth, eClinicalWorks, Optivate, and ModMed. If your primary care practice uses another EHR, a dedicated engineer builds a custom integration.
- How do primary care practices get started?
- Every practice starts with a complimentary retroactive audit of recent primary care charts and claims. Syntra then moves to controlled pre-bill review and, over about 90 days, autonomous submission on eligible encounters with humans in the loop.
See other specialties, EHR integrations, or how pre-bill review works.
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