Laboratory Prior Authorization2019-05-22T08:56:41+00:00

The Problem

Lack-of-automation-Infinx

Prior Authorization Approval

Prior authorization requirements in the laboratory space create unique and complex challenges. The payment lifecycle for laboratories begins with prior authorization. Receiving prior authorization approval after performing a lab test is becoming a less viable option; as is fighting denials for lack of prior authorization approval during the appeal process. Some payors are still allowing retroactive authorizations; however, laboratories which test specimens without prior authorization run the risk of performing uncompensated tests.

Processing prior authorizations manually specifically for genetics and molecular testing often creates lost authorizations, decrease in patient satisfaction, and higher denial rates. Also, labs have complex and expensive CPT codes that often create significant challenges in gaining prior authorization approvals. As a provider, you can’t complete the test until you receive the approval, which often requires navigating proprietary and nonstandard workflows. Getting approval is critical to preserving revenue through the entire process.

The Solution – Automate Your Prior Authorization

A Scalable Prior Authorization Solution

Infinx Patient Access Software evaluates each case to determine which cases can be automated by AI. Exceptions are managed by our trained and certified team of preauthorization experts.

A Complete Prior Authorization Software for Labs and Pathology

Artificial Intelligence to Transform
Your Lab and Pathology Prior Authorizations

Infinx Patient Access Software for labs and pathology blends automation, integration, cognition, and control to offer you an optimized workflow. It leverages our AI & HI capabilities to provide a robust and seamless solution for managing prior authorization cases. AI optimizes your workflow and automates cases than can be immediately completed, or require no-auth. Cases needing more in-depth attention are forwarded to our global team of specialists who can process your prior authorizations with speed and impeccable accuracy.

Infinx Patient Access Software is built on iBridge, our comprehensive product platform with built-in critical modules that allow you to expand as you grow. The prior authorization module includes seamless HL7 integration to your EHR, and a vast network of clearinghouse integrations, helping you maximize your collections while minimizing denials.

No Auth
Decision Engine

Determining if a case requires a prior authorization shouldn’t be hard. That’s why we’ve created our No Auth Decision Engine to give you immediate insight if a case needs a prior authorization, before spending the time to call a payer. This process can cut as much as 30% of your workload just by reaching a decision ahead of time.

Exception Handling by Proven Experts

Laboratories need to re-evaluate their prior authorization strategy. Prior authorizations for labs are complex and inevitably require human intelligence to manage the exceptions. In-house teams often have error rates as high as 35%, which creates a drain on resources and revenue. You can improve your patient access by enhancing and automating your prior authorization process so that you can skip the challenges and see immediate benefits in your workflow.

Our solutions help you get ahead of the revenue cycle problem by quickly authorizing and confirming every test rendered and can be billed with near certainty to its accuracy and propensity to collect. Our experience working with payors nationwide, allows you to receive same day appointments within 4 hours, and 100% accuracy and adherence to a 24-hour TAT, enabling you to capture more revenue for your lab.

3.21 Exception Handling

Prior Authorization Features:

Real-Time Data
You Need Now

Automate your preauthorization. Get the data you need immediately to make good decisions about patient payment and scheduling.

No Auth Required
Decision Engine

Get immediate results to determine whether or not a preauth is required for services rendered.

Optimized
Scheduling

With a real-time recommendations for noauth requirements and prior authorization ETA, you can schedule your patients with certainty.

Exception
Handling

Cases that cannot be automated are handled by experts who are deeply knowledgeable on payor guidelines and protocols.

Web Portal or
Seamless Integration

We give you options for to view information in a web portal view, or seamless HL7 integration with your existing EHR.

Extensive Payer and
Clearing House Integrations

Extensive Payer and Clearing House Integrations for a robust coverage for your insurance eligibility needs.

How We Do It

3.21 How We Do It
1

1

Pull Patient Information

The software pulls this information in via an HL7 message from the client’s system.
2

2

Prior Authorization Requirement

The software automatically interfaces with the payor system to check if there is a prior authorization requirement.
3

3

Prior Authorization Completed

The software automatically sorts the prior authorization by priority of urgency of care, and prepares and files paperwork through the secure EDI with the payor. The Infinx team handles any exceptions.
4

4

Sent to Client System

The prior authorization package is automatically sent back to the client's internal system, where it can be printed or emailed to the team or patient.
1

Pull Patient Information

The software pulls this information in via an HL7 message from the client’s system.

2

Prior Authorization Requirement

The software automatically interfaces with the payor system to check if there is a prior authorization requirement.

3

Prior Authorization Completed

The software automatically sorts the prior authorization by priority of urgency of care, and prepares and files paperwork through the secure EDI with the payor. The Infinx team handles any exceptions.

4

Sent to Client System

The prior authorization package is automatically sent back to the client's internal system, where it can be printed or emailed to the team or patient.

Our Results

Prior Authorizations
Daily:
4,000+
Satisfied
Customers:
100+
Reduce
Denials by:
50%
Accuracy
Rate:
>99%