Accelerate Revenue for
Diagnostic & Clinical Labs
Diagnostic labs process massive daily volumes. We automate and optimize your revenue cycle, ensuring strict CLIA compliance, mastering the 80000 CPT series, and preventing devastating unbundling denials.
99% Clean Claim Rate
We deploy advanced scrubbing rules to verify correct organ or disease-oriented panel billing, eliminating overlapping component codes.
Handling Complexity at Scale
Independent labs, pathology centers, and molecular diagnostics facilities face intense scrutiny over medical necessity (NCD/LCDs) and unbundling. A generic billing approach will result in thousands of unpaid micro-claims. Our infrastructure is built to process lab volumes efficiently and accurately.
Panel Unbundling Prevention
When performing a Comprehensive Metabolic Panel, billing for individual chemistry tests will trigger NCCI edits. We automate rules to combine components into correct panel codes.
Accession & Modifiers
We flawlessly apply lab-specific modifiers like QW (CLIA waived), 90 (Reference Lab), and 59/91 for distinct or repeat clinical diagnostic tests.
NCD/LCD Medical Necessity
Medicare has strict Local and National Coverage Determinations for labs. We verify that the referring physician's ICD-10 codes explicitly support the ordered tests.
From Specimen Collection
to Final Remittance
We bridge the gap between your LIS (Laboratory Information System) and payer portals to ensure seamless data transfer and rapid claim processing.
Requisition Capture
Data is extracted from your LIS. We verify that patient demographics, referring provider NPI, and accession numbers are 100% accurate before processing.
Diagnosis Verification
Our system checks the requested tests against the provided ICD-10 codes. If medical necessity isn’t met, we immediately query the ordering physician.
High-Speed Scrubbing
Claims are processed through advanced scrubbing engines designed for high-volume lab environments, checking for bundling issues and CLIA certification mismatches.
Micro-Denial Recovery
Lab denials are often low-dollar but high-volume. We don't ignore them. Our automated appeals system efficiently challenges "non-covered" or "experimental" denials.
Stop Losing Money to
Missing Information Denials
Partner with an expert billing team that understands LIS integration, CLIA modifiers, and high-volume denial management. Contact Valeria Healthcare Solutions today.