Labs & Diagnostics

High-volume claims discipline that protects margin

Labs win on throughput and precision. A small edit drift or payer-rule change can erase margin at scale. We install edit governance, denial taxonomy, and operational cadence so volume converts to cash predictably.

Request a Conversation Where revenue breaks KPIs

ControlsQueue disciplineEscalation pathwaysExecutive cadence

Edit governanceRules tracked and maintained

ThroughputFewer rework touches

PreventionDenials drive upstream fixes

Labs & Diagnostics

Convert volume to cash with rule-driven workflow control

We install controls and a weekly cadence so performance is repeatable across teams, payers, and locations — without heroics.

Discreet resolution capability: We keep payer recovery professional: documented, controlled, and aligned to contractual rights.

Where cash breaks

Typical failure modes we map in the first 10–14 days.

Signals

Eligibility/coverage edits spiking for specific payers
Medical necessity/ABN issues by test type
Ordering source variability causing denials
Underpayments hidden in high-volume remits
Resubmission loops with no root-cause closure

Root causes

Missing controls (no owner, no cadence)
Work queues misaligned to payer rules
Documentation + coding handoffs inconsistent
Appeals built ad-hoc instead of industrialized

The operating model we install

A control system: dashboards → queues → escalation → weekly exec cadence.

Interventions

Front-end eligibility + necessity controls at order capture
Denial root-cause by test, payer, site, ordering source
Contract variance modeling + automated recovery queue
Clean claim playbooks for top 20 tests/payers

What you get

Playbooks, templates, and manager scorecards
Queue design + SLA definitions per workstream
Payer performance reporting and variance tracking
Weekly leadership readout (10-slide style)

KPIs leadership can run

We choose a tight set of measures that drive behavior and closure.

First-pass yield

↑

claims clean

Days in AR

↓

faster closure

Underpayment recovery

↑

variance captured

Resubmission rate

↓

root causes closed

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