How to get paid: Payment Process Guide

When an order becomes payable, how monthly statements and payment timing work, timely filing, reconciliation, payment and denial reasons, and lost, stolen or broken equipment.

This guide is information only and seeks to provide a summary of how processes work, aligned to our Handbooks, contractual arrangements, and established network policies.

Payment overview

Synapse Health groups eligible, completed orders and invoices into monthly payment statements. Statements explain payment activity and may include payment or denial reason information. Subcontracted providers should monitor Synapse workflows throughout the billing process rather than waiting for the monthly statement to identify work that requires action.

To check where an individual order stands, use Order Payment Status in the Fulfill portal. For what each order status means, see the Fulfill order status guide.

• Synapse Health pays subcontracted providers in arrears.
• Statements are generated from eligible, completed orders and invoices from the prior calendar month that have not previously been paid.
• Each standard monthly statement covers only completed orders and invoices from that single prior calendar month.

When an order is payable

An order must meet established requirements to be completed and invoiced in Synapse Health systems before it can flow to the monthly statement process. Synapse Health does not issue provider payment solely because equipment was delivered or documentation was submitted.

• A payable order is complete, invoiced, within the applicable timely filing window, and otherwise eligible under the subcontracted provider agreement and payment rules.
• By way of example, if required documentation, patient contact, or adherence connectivity is incomplete or missing, the order may remain outstanding. Payment is held until the issue is resolved and the order can be completed.
• Submitting documentation does not guarantee payment. Completed orders remain subject to review by Synapse Health, including for matters related to eligibility, medical necessity, and payment rules.

Monthly statements and payment timing

Statement delivery and storage

Statements are uploaded to the provider’s secured ShareFile portal. Users with access receive an electronic notification that the statement is available for download.

• Retain each statement and use the identifiers provided to reconcile payment activity to accounts receivable records.
• Use the Synapse order or sales order identifier and any mapped provider unique identifier shown in the statement.
• Maintain current authorized ShareFile users and access.

Statement reconciliation window

• In accordance with our handbook, providers have 30 days from the applicable statement date to submit a reconciliation request involving a paid, partially paid, or denied invoice.
• The reconciliation period does not extend the timeframe by which timely documentation must be submitted.
• Use Fulfill to monitor orders and documentation requests throughout billing so documentation is submitted on time.
• Reconciliations received within the first week of the month may be considered for the next payment statement.
• Reconciliations received after the first week of the month move to the subsequent statement cycle, consistent with standard processing timelines.

Timely filing requirements

Timely filing is the maximum number of days from the date of service within which an order and its required documentation must be received by Synapse Health for the item to be eligible for payment.

Standard orders

• Proof of Delivery must be submitted within 90 days of the date of service.
• Date of service means the ship date for mail-order fulfillment or the delivery date for threshold or live deliveries made within the home or branch.
• In accordance with our agreements, orders generally require approval by Synapse before delivery occurs.

Vendor Order Completed orders

• The order information must be received by Synapse Health within 5 days of the date of service with a complete delivery ticket
• Required documentation, including the Standard Written Order, Proof of Delivery, and supporting medical records when applicable, must also be received within 90 days of the date of service.
• If the order or any required document is received after the 90-day window, it is not eligible for payment for that date of service.

Rental billing resumption

• For rental orders pending required documentation, billing resumes once the proper documentation, including the Standard Written Order, Proof of Delivery, and supporting medical records when applicable, is received.
• Resumed billing is applied 90 days in arrears from the date required documentation is received. Billing begins from the point 90 days before the documentation receipt date and continues forward month by month, rather than returning to the original rental start date.
• If an order is submitted after the standard timely filing window, rental billing resumes at the most recent date of service within the timely filing period and extends the rental program to capture remaining rental months that were not billed because of the delay.
• Remaining rental months are payable only if patient contact and active equipment usage during the rental period are confirmed. Months for which contact and usage cannot be confirmed are not paid.
• This rental extension treatment applies only to rental equipment. For purchase orders submitted after the standard timely filing window, the affected date of service may remain ineligible for payment.

How to reconcile a statement

A payment reconciliation is generally used to appeal a paid, partially paid, denied, or non-payable invoice or another payment determination on an identifiable Synapse order, invoice, or payment statement, unless otherwise specified by Synapse Health. The reconciliation process is not, for example, utilized to submit incomplete documentation, create missing or new orders, or extend the window for timely submission of information.

What reconciliation can cover

• Paid invoices.
• Partially paid invoices.
• Denied or non-payable invoices.
• Payment amounts or contracted reimbursement.
• Previously paid or duplicate-payment determinations.
• HCPCS or item mismatches.
• Date-of-service eligibility.
• Orders identified as cancelled, using the cancelled-order workflow below.
• Other payment or denial reasons displayed on the statement or reconciliation detail.

What reconciliation cannot do

• Create an order after the filing deadline.
• Submit missing required documentation after the deadline and automatically restore payment eligibility.
• Extend the timely filing period.
• Reopen an order solely because it appears on a provider’s accounts receivable report.
• Move aged accounts receivable into a newer statement cycle.
• Resolve an order that remains outstanding in Fulfill.
• Create a missing patient or order.
• Repeatedly resubmit a previously reviewed item without new evidence.

Submission method

• Complete the Synapse Health Payment Reconciliation Form associated with the statement.
• Include all required fields for each disputed line.
• Identify the Synapse order number, invoice number, date of service, HCPCS, disputed amount, and dispute reason, when available.
• Include a concise explanation of the requested correction.
• Submit one consolidated reconciliation file for the applicable statement period through the designated secure submission location.
• Return the file to the Accounts Receivable & Invoices folder in ShareFile.
• Retain confirmation of submission.

Incomplete submissions may be returned without determination. Multiple fragmented files, supplemental spreadsheets, or individual reports may delay review and are not accepted in place of the required consolidated submission. One standardized file per reporting period is required, with all supporting documentation needed for review.

Information for each disputed line

• Provider name.
• Patient or member policy number.
• Synapse sales order number, preferred.
• Provider order or account number.
• Invoice number, optional.
• Date of service.
• HCPCS code.
• Item type: purchase or rental.
• Item description, preferred.
• Amount billed.
• Amount disputed.
• Payment or denial reason shown by Synapse Health.
• A clear explanation supporting the request.

Synapse Health review and statement-cycle processing

• Synapse Health evaluates reconciliation using available order, invoice, payment, and system information and documentation.
• Synapse Health may correct an identified payment error regardless of whether the error favors Synapse Health or the provider.
• Once an outstanding order, or an order with no patient or order on file, is fully resolved and completed, payment follows the standard process and enters the next applicable payment cycle.
• Submission within the first week does not guarantee inclusion in the next statement if required information is missing, additional review is needed, or the determination is not complete before statement finalization.

Duplicate and supplemental submissions

• A provider may respond to or resubmit an appeal for the same date of service once.
• Do not resubmit the same date of service in later statement periods unless Synapse Health requested information, new documentation materially affects the determination, Synapse Health instructed resubmission, or the prior determination expressly allowed reconsideration.
• Repeated submission without new or materially different support may be classified as a duplicate and closed without additional review.

Records and questions

• Retain the original reconciliation submission.
• Retain supporting documentation and submission confirmation.
• Retain Fulfill notes and uploads.
• Retain Synapse Health’s determination and requested follow-up information.
• Direct reconciliation questions to your assigned Statement Analyst, your designated Synapse Health account representative, or vendorstatementsconnect@synapsehealth.com.

Requests that do not meet these requirements

Reconciliation requests that do not satisfy the data and information requirements needed to achieve resolution may result in return of an incomplete submission, deferral to a later statement cycle, redirection to Fulfill or another required workflow, the original payment determination being upheld, denial due to untimely submission, or closure as a duplicate or unsupported request. Synapse Health may request additional information and correct payment or processing errors identified during review.

Which system or form to use

Outstanding orders

• Review and resolve pending documentation requests, incomplete orders, and unresolved inquiries directly in Fulfill.
• An order that remains outstanding in Fulfill is not resolved through the Payment Reconciliation Form. A reconciliation line for that order is redirected for operational resolution and is not processed as a dispute until the outstanding item is closed.

No patient or no order on file

• Submit the order through Connect or another applicable integration.
• Include all required supporting documentation when submitting. If support is missing, the order remains in Outstanding Orders status until the documentation is provided and the order can be fully processed.
• Timely filing continues to apply.

Pickup requests

For returns or pickup requests, add a note on the individual order in Fulfill (see pickup scenarios in Fulfill) or use the Returned Equipment Template included with the monthly provider statement.

Cancelled order reconsideration

Do not submit a cancelled order solely as a line on the Payment Reconciliation Form. If you disagree with or need to appeal a cancellation, submit reconsideration directly on the applicable order in Fulfill.

1. Locate the cancelled order in Fulfill using Order Lookup.
2. Upload all supporting documentation to the order.
3. Add a note labeled “Cancelled Order Reconsideration Request.”
4. Explain why the cancellation was incorrect.
5. Identify the requested resolution.
6. Include the relevant date or dates of service.
7. Confirm that all supporting documentation was uploaded.
8. Submit the note and documents within applicable timely filing and reconciliation requirements.

Documentation examples

A reconsideration request does not automatically guarantee payment, suspend or extend timely filing, establish eligibility outside the filing period, or replace other order, patient, contract, or documentation requirements. Synapse Health may uphold the cancellation, correct the reason, reopen or return the order for processing, request information, determine certain dates remain outside timely filing, or approve another resolution supported by the evidence.

Payment and denial reasons

A statement may contain payment or denial reason information explaining an item’s disposition and, when applicable, the action needed. A denial does not automatically mean the item can be corrected and paid. Use the stated reason and action guidance to determine whether correction or reconciliation is appropriate.

Payment adjustments

Synapse routinely monitors provider payment data and reconciliation processes to validate payment accuracy and eligibility. If a review identifies a payment issued in error, duplicated, or otherwise ineligible, Synapse may initiate an appropriate payment adjustment.

• The affected account or accounts are identified as a Payment Adjustment on a subsequent provider statement.
• The prior-payment amount is deducted from the current statement balance or payment.
• Adjustment details are provided at the account or order level to support reconciliation and transparency.
• Providers may ask questions or submit supporting documentation through the established statement reconciliation process.
• Adjustments may result from duplicate payments, eligibility changes, order corrections, documentation findings, or other payment-validation findings.

Lost, stolen, or broken equipment

These requirements apply to equipment delivered to a patient that later becomes lost, stolen, or non-repairable.

DME provider responsibilities

• Notify Synapse within 90 days after identifying lost, stolen, or broken-beyond-repair equipment, or when Synapse requests pickup.
• Submit required support, including outreach attempts, a police report, manufacturer confirmation, a repair invoice, or natural-disaster documentation, as applicable.
• Coordinate with Synapse during follow-up, investigation, or replacement.
• Insurance changes are not in scope for this process.

Identification and notification

• Submit written notification using a Fulfill note within the 90-day window above.
• Include the patient identifier, including date of birth, name, and policy number; equipment identifier, including serial number or asset tag; incident category; incident date; and a brief description.

Documentation by incident type

• Lost: written record of reasonable recovery attempts.
• Stolen: official police report.
• Broken beyond repair: written confirmation from the manufacturer or service provider, or a repair invoice showing non-repairability.
• Natural disaster: support such as fire or flood reports, insurance claims, or third-party confirmation.

Review and resolution

• Synapse Operations reviews the notification and support and requests missing information when documentation is incomplete.
• Once verified, the incident is logged on the order and categorized.
• For lost equipment when the provider could not contact the patient and requests payment, Synapse makes three additional patient contact attempts.
• Based on the contact attempts, Synapse determines the next steps, including replacement, billing adjustment, insurance claim, or write-off as appropriate.
• If applicable, payment is based on the reimbursement rate in the provider agreement.
• Inventory and patient records are updated, and the provider is notified of the resolution and any further action.

Provider responsibilities

• In accordance with our Handbooks, providers are asked to monitor Fulfill and other approved Synapse systems for outstanding orders, documentation requests, patient-contact activity, pickup requests, cancellations, and other required actions.
• Submit complete and accurate orders and documentation within applicable timely filing deadlines.
• Review each monthly statement promptly and reconcile payment and denial reasons to internal accounts receivable records.
• Submit one complete reconciliation package with supporting documentation through the required system and within the required window.
• Maintain accurate ACH and payment information (use the ACH Authorization Form to update it) and current authorized ShareFile users.
• Do not wait for the monthly statement to identify missing orders, documentation, incomplete work, requested patient contact, pickups, cancellations, or other required actions.

Important distinctions

Definitions

Related articles

• Billing scenarios explained
• Delivery confirmation policy and the 5-day window
• Member transition actions for DME providers
• Synapse Health DME Provider Contact List