Fix Revenue Gaps Before Claims Reach Billing
Laboratory
Pre-Billing Solutions
Resolve demographic errors, verify coverage, and satisfy pre-claim requirements before preventable denials ever disrupt reimbursement. Built specifically for laboratory workflows, Access Management solutions connect eligibility verification, insurance discovery, prior authorization, and pre-billing validation into one coordinated upstream process that keeps claims moving forward.
Prevent Upstream Errors from Slowing Down Reimbursement
Correct patient data, confirm active coverage, and resolve payer requirements before billing workflows begin. Eliminate disconnected intake processes that create avoidable denials, manual rework, and delayed reimbursement later in the revenue cycle.
Connect eligibility verification, insurance discovery, prior authorization, and pre-billing workflows through one coordinated process designed specifically for laboratory billing operations.
Explore Solutions for Every Stage
Build a more connected revenue cycle with solutions designed to improve visibility, automate workflows and keep revenue moving.
Clearinghouse
Route Laboratory Claims Through a Clearinghouse Built for Lab Billing
Process eligibility, claims, remittances, routing, and transaction validation through a medical claims clearinghouse designed specifically for laboratory revenue cycle operations. Validate claims automatically, apply payer-specific edits in real time, and reduce manual intervention before claims ever reach the payer.
- Process major EDI transaction types through a clearinghouse with lab-specific editing logic
- Apply real-time payer rules across 5K+ payer connections to improve claim accuracy
- Enforce medical necessity with LCD/NCD, CCI, MUE, and Z-Code validation
- Route Blue Card claims accurately based on provider, draw site, and payer rules
- Connect LIS, LIMS, HIS, and PMS systems through integrated workflow architecture
- Reduce manual intervention through automated validation, routing, and rejection workflows
Eligibility Verification
Verify Active Coverage Before Claims Enter the Revenue Cycle
Confirm coverage, correct patient data, and identify payer information before eligibility issues create downstream denials. Run automated eligibility and insurance verification workflows continuously to reduce manual follow-up, improve reimbursement accuracy, and keep claims moving across high-volume laboratory billing environments.
- Verify eligibility in real time through 270/271 transactions across Medicare, Medicaid, commercial, managed care, IPA, and dual eligibility plans
- Process batch eligibility verification workflows built for high-volume lab billing environments
- Correct and repair patient demographic errors before eligibility issues disrupt reimbursement
- Identify Medicare beneficiaries through integrated MBI Assist workflows
- Improve BCBS verification accuracy with Blue Card prefix mapping and product-level routing
- Route eligibility outcomes intelligently through 200+ configurable business rules and direct HIS, PMS, and LIMS integrations
Insurance Discovery
Identify Hidden Coverage Before Revenue Goes Missing
Find secondary coverage, newly active plans, and unreported insurance before accounts default to self-pay or uncompensated care. Improve payer matching accuracy upstream and reduce downstream billing errors before claims move into reimbursement workflows.
- Discover secondary, tertiary, and unreported insurance coverage automatically
- Identify Medicare Advantage, Medicaid, MCO, IPA, and dual eligibility plans earlier
- Reduce self-pay designations through active coverage matching workflows
- Correct demographic and payer data before claims move into billing
- Automatically apply discovered coverage across downstream workflows
- Convert more accounts into reimbursable insurance claims while reducing write-offs
Pre-Claim Requirements
Resolve Prior Authorization and Medical Necessity Earlier
Verify payer-specific requirements before tests are ordered, processed, or billed. Prevent administrative denials tied to missing prior authorization, medical necessity gaps, or incomplete documentation before revenue slows downstream.
- Verify prior authorization requirements in real time by payer, plan, and test type
- Screen Medicare and commercial claims for medical necessity compliance automatically
- Support physician outreach and medical record collection workflows
- Store payer-specific authorization rules, forms, and documentation requirements centrally
- Trigger automated follow-up and escalation workflows before filing deadlines expire
- Reduce administrative denials and manual rework tied to authorization failures
Pre-Billing Support Services
Validate Billing Data Before Claims Move to Submission
Coordinate demographic validation, compliance checks, charge workflows, and exception handling before claims enter the billing queue. Reduce preventable claim errors earlier and strengthen reimbursement accuracy across laboratory billing operations.
- Validate demographics, charge entry, CPT, HCPCS, and diagnosis data before submission
- Apply payer-specific edits, pricing rules, and compliance workflows automatically
- Process HL7, API, JSON, and batch file integrations across connected systems
- Flag incomplete, inaccurate, or non-compliant records for earlier resolution
- Support patient financial clearance and out-of-pocket responsibility workflows
- Route billing exceptions intelligently before claims are generated
Pre-Billing Workflow
Connect Every Upstream Workflow Before Claims Reach Billing
Unify eligibility, insurance discovery, authorization, and validation workflows into one coordinated pre-billing process. Resolve exceptions before submission and improve first-pass acceptance through configurable workflows aligned to laboratory operations.
- Connect eligibility, discovery, authorization, and validation workflows in one process
- Route exceptions automatically by issue type, urgency, and workflow status
- Configure workflow logic by payer, test type, and laboratory billing policies
- Escalate unresolved issues through time-sensitive routing and follow-up rules
- Monitor workflow performance, exception resolution, and cycle times in real time
- Improve claim quality before submission reaches the payer
Strengthen Revenue Performance Before Denials Ever Happen
Resolve access issues before claims are created, not after reimbursement fails. Apply 30+ years of laboratory billing expertise to workflows designed specifically for laboratory complexity, payer behavior, and high-volume diagnostic operations.
Keep claims cleaner, reimbursement faster, and denial pressure lower by strengthening the workflows that influence revenue earliest in the cycle.
“Our sincere thanks to you and the Quadax team for guiding us through this implementation. We’re thrilled to have met this milestone and to be going live on time.”
VP Finance, Solvd Health
“Your partnership has made every transition smoother than it could have been otherwise. Your responsiveness and collaboration have made a big difference, and I’m very grateful for all that you do.”
Billing Operations Specialist, BostonGene
“Quadax made transitioning our lab from in-house billing to their full-service offering an absolute breeze. We could not be happier with both the operational and financial improvements we have seen from partnering with Quadax.”
VP Finance, Streamline Scientific
Laboratory Resources
Fix Pre-Billing Issues Before Revenue Slows Down
Verify coverage earlier, resolve requirements faster, and prevent avoidable denials before claims ever reach billing.