LigoLab Offers Labs an Automated and Real-Time Software Solution for Prior Authorization Requirements
November 17, 2023
LOS ANGELES, CA – April 22, 2021 -- LigoLab, developers of enterprise software that helps medical laboratories scale their operations, today announced that its LIS & RCM platform supports an automated real-time solution that reduces the administrative burden that laboratories face when attempting to meet payer prior authorization requirements. The solution helps prevent denials, speeds up prior authorization approval, and closes a coverage gap that could otherwise put the patient at risk.
The LigoLab LIS & RCM Operating Platform is fully integrated with the laboratory information system (LIS) and revenue cycle management (RCM) modules sharing a single database and operating system. This enables consistent data to flow freely through both modules with no silos, providing a single source of truth. With this degree of integration, laboratories can begin the billing cycle at order creation. Additionally, they can leverage powerful claim scrubbing and billing automation and engage direct interfaces with third-party services that specialize in patient demographic verification, insurance eligibility, and insurance discovery.
“Obtaining prior authorization is often difficult and labor-intensive, and it usually requires a substantial amount of supporting documentation, plus several faxes and phone calls,” said LigoLab Billing Manager Farzad Abdi. “The process also typically varies greatly from one insurer to another, which means it’s hard to standardize.”
To prevent lost revenue, mitigate audit risk, and ensure patient satisfaction, Abdi said labs should consider the benefits that come with full bi-directional synchronization with third-party services that can electronically manage prior authorization requirements and cross-check, verify, and update patient demographic and insurance information at the point of care.
“By directly interfacing with clearinghouses, mailing companies, the NPI Registry, and payment processors, labs gain access to live payer and patient verification tools that not only assist with prior authorization but also ensure all claims are scrubbed sufficiently before submission. This makes them more likely to be accepted on the first pass,” said Abdi.
Abdi also noted that Ligolab’s rule-driven claim scrubbing engine provides another layer of protection for laboratories against denials.
“With our platform and its million-plus rules, laboratory operators can set up custom rules based on identified payer regulations and requirements. These rules automatically check for denial patterns so the same mistakes aren’t repeated,” he said.
For more information, please visit RCM.LigoLab.com.
LigoLab is a leading provider of innovative end-to-end healthcare software for laboratories, servicing 100+ facilities nationwide. As a comprehensive enterprise-grade solution, the LigoLab LIS & RCM Laboratory Operating Platform™ includes modules for AP, CP, MDx, RCM, and Direct-to-Consumer, all-in-one integrated platform that supports every role, department, and the entire lifecycle of all cases, enabling laboratories to differentiate themselves in the marketplace, scale their operations, and become more profitable. LigoLab’s RCM module is deeply integrated with the LIS. It automates ICD and CPT coding and many other financial tasks while also mitigating audit risk and increasing margins. Billing processes start at order creation with verification, eligibility, and scrubbing components that increase clean claim submissions and revenue, and decrease claim denials and compliance liability.