Struggling with denials, aging A/R, or revenue leakage? Our end-to-end independent clinical laboratory billing services help labs get paid faster and more accurately, reducing billing stress and ensuring cleaner claims from start to finish.
| Sr. | Challenges | Problem | Solution |
|---|---|---|---|
| 01 | Denied Claims for “Medical Necessity. | Wrong ICD-10 mapping or missing documentation. | We automate ICD-10 pairing and validate medical necessity in real time. |
| 02 | Missing or Incorrect CLIA Info | Denials due to missing CLIA numbers or incorrect modifiers (QW, 90, 59, 91). | We perform pre-submission CLIA checks and audit all modifiers. |
| 03 | High Denials for Molecular & Genetic Testing | PCR, molecular, and genomic codes (87426–87999, 81200–81408) are heavily audited. | We align with CLFS, handle PAMA reporting, and perform thorough documentation audits. |
| 04 | Slow Payments & Long A/R | Slow Payments & Long A/R | We integrate HL7/FHIR, automate workflows with RPA, and actively monitor A/R to keep it under 25 days. |
| 05 | Charge Entry Delays | Unposted charges cause revenue loss. | 24–48 hr charge entry with reconciliation. |
| 06 | MolDX & Z-Code Registration | Reimbursement delays from complex TA submissions and Z-Code registration. | We manage submissions and registration to ensure smooth, timely payments. |
Full-Cycle Laboratory Revenue Cycle Management
Lab Coding & Reimbursement Services
Automated Lab Billing Workflows
Automated denial tagging
Patient Billing & Collections:
PCR, infectious disease, COVID, respiratory panels, and genetic sequencing.
Tox screens, chemistry panels, drug testing workflows.
Biopsies, cytology, PAP tests, and histopathology workflows.
Cultures, sensitivities, and organism identification.
Next-generation sequencing (NGS), cancer biomarkers, and pharmacogenomics.
CLIA high-complexity test documentation & coding accuracy.
Smooth submissions and timely reimbursements for molecular and genetic tests.
| Denial Code | Meaning | Why It Happens | How We Prevent It |
|---|---|---|---|
| CO-50 | Not medically necessary | Wrong ICD pairing | Automated ICD mapping |
| CO-16 | Missing information | Missing CLIA, modifier, order | Pre-submission validation |
| CO-4 | Inconsistent modifier | Wrong QW, 90, 59 | Modifier audit workflows |
| CO-170 | NCCI edit | Bundled CPT | NCCI validation |
| CO-29 | Timely filing | Late claims | 24–48 hr filing |
| CO-97 | Non-covered service | LCD/NCD mismatch | LCD rules engine |
| RARC M12 | Missing order | No documented order | Order verification |
Chemistry / Hematology / Immunology:
Preventive Screening (Medicare G-codes)
Molecular Diagnostics:
Genetic Testing:
Paired ICD-10 Examples:
Epic, Cerner, eClinicalWorks, Athenahealth, Sunquest, Orchard, Clinisys, LabWare, LigoLab, and SoftLab. We connect seamlessly via HL7/FHIR to ensure smooth data flow.
RPA bots map test codes, verify CLIA, validate CPT/ICD combos, and queue clean charges.
Dedicated denial specialists bring A/R below 25 days.
Most labs see reimbursement cycles drop to 10–14 days.
We update codes based on CLFS changes to prevent underbilling or incorrect rate claims.
We assist with data collection, pricing validation, and audit support.
Coverage rules for preventive tests, G-codes, and medical necessity updates.
We ensure your billing matches your MAC’s policies: Novitas, Palmetto, NGS, and WPS.
Transparent pricing, documentation, and patient-friendly statements.
With all the changes happening in PAMA reporting, CLFS rate updates, new CPT codes, and new MUE edits, your revenue can shift quickly if you’re not ahead of it. We build forecasting models that account for:
Why This Matters
The Answers You’re Searching For
We handle all clinical lab billing specialties, including:
Molecular Diagnostics & Genetic Testing
