syneri.ai provides an AI-powered revenue protection infrastructure for healthcare clinics that bill health insurance plans. The platform addresses the full billing cycle—from patient eligibility checks to automated claim denials management—integrating with existing systems via API without requiring migration. It has protected over R$18 million in revenue for partner clinics, achieving a 97% first-submission approval rate.
Funding
Funding not disclosed
Founders
Product
Problem
Healthcare clinics billing health insurance plans face complex, manual billing processes that are prone to errors, resulting in claim denials and lost revenue. Most clinics only discover revenue losses after it is too late, with an estimated 17% of clinic revenue at risk due to inefficient billing workflows and lack of proactive prevention.
Solution
syneri.ai provides a comprehensive AI infrastructure that protects clinic revenue across the entire billing cycle, from patient eligibility to claim denial appeals. The platform consists of five integrated modules—Eligibility, Clinical Support, Pre-submission Audit, Appeals, and Legal—that can be activated individually or together. It connects to existing clinic systems via API, eliminating the need for system migration or IT projects. The AI is fully auditable (Glass Box), ensuring every decision is traceable and explainable, while operating with up-to-date regulatory tables (TUSS/TISS) and ANS standards.
Target Audience
Primary customers are healthcare clinics that bill health insurance plans (convênios), including specialty clinics such as endocrinology, nutrition, and other medical practices seeking to reduce claim denials and protect revenue.
Features
- Eligibility module verifies active coverage, waiting periods, and provider networks before patient care to prevent non-covered services
- Clinical Support module uses intelligent scribing and CID x Procedure validation to ensure documentation supports billing claims
- Pre-submission Audit cross-references clinical context, ANS rules, and contracts to correct inconsistencies before claim submission
- Automated Appeals module generates contestation documents with intelligent prioritization, eliminating abandoned claims
- Legal module compiles complete case dossiers in hours for negotiation with operators or legal action
- LGPD-native data handling with end-to-end encryption, data stored in Brazil, and role-based access control