CASE STUDY

Prior Authorization Volume Quadrupled and Turnaround Times Slashed for National Clinical Laboratory

The Background

In Spring 2018, a prominent San Francisco based clinical laboratory with a focus on prenatal genetic screening was poised to ramp up production significantly and sought an innovative prior authorization solution that could handle the increased number of clients.

The clinical lab launched a pilot program with Infinx to handle roughly 1,000 jobs – primarily prenatal and carrier screenings for female patients during the ninth week of their pregnancy. Because of the highly sensitive nature of the screenings and the potential for growth, the lab chose our Prior Authorization Software solution for its proven track record for speed, transparency and accuracy.

In addition, the lab was attracted by our familiarity with insurance companies and prior authorization requirements in regions instrumental to their business such as Texas, Illinois, and Maryland.

65%

IN-HOUSE ACCURACY

The average accuracy rate for in-house prior authorization teams.

98%

INFINX ACCURACY

The average accuracy rate of our Prior Authorization Software.

The Pilot

The initial prior authorization pilot project consisted of 1,000 jobs and required less than a month to complete. We were able to handle roughly 50 accounts a day with 98 percent accuracy. We were also able to shave off a day on the prior authorization turnaround time – from four days to three.

The client was highly pleased with the results of the pilot program and the positive effect on its denial management metrics. After the pilot project had concluded, we sat down with the client and showed them how we could continue to boost revenue at scale. The lab was highly motivated as they were in the process of transitioning to a bigger organization and wanted to demonstrate the highest possible profitability

Quadrupled Prior Authorization Volume

On the heels of the successful pilot project, the lab contracted with Infinx to handle more volume. Infinx now handles over 100 prior authorizations per day, which quadrupled the laboratory’s original volume. Payors included Tricare East, Medicaid Connecticut, UMR – Sutter Select, among others.

In total, Infinx successfully addressed 7,130 jobs with over 98 percent accuracy.

  • Designed for Scale and Accuracy:Infinx conducted over 7,000 prior authorizations and maintained a 98 percent rate of accuracy, which included approximately 1,000 jobs.
  • Continually Optimized:Infinx’s quality group conducted audits that allowed our client to track the agreed upon metrics so that our process continued to optimize.

Optimize Your Clinical Laboratory Prior Authorization Process

Infinx is a healthcare technology company offering prior authorization and revenue cycle management solutions to help preserve and maximize revenue for hospitals, imaging centers and laboratories.

The Results

>98% ACCURACY= PEACE OF MIND

  • Overall >95% successful authorization rate on prior authorizations
  • >99% error-free audits on all documentation
  • 100% compliance to all payor guidelines and protocols

Let’s Optimize Your RCM Workflow

Schedule a call with our team to learn how our solution can help optimize your revenue cycle.

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