Payers
Medical Database has developed innovative solutions to help payers reduce costs by ensuring all tests meet medical necessity, minimizing unnecessary testing (CPOE), and automating prior authorization and claim verification processes with LabAI
CPOE (Computerized Provider Order Entry)
The test-ordering system, CPOE is specifically designed to integrate seamlessly with EMR, EHR and LIS systems, to help healthcare providers select and order the most appropriate lab tests using evidence-based guidelines and industry best practices.
CPOE is backed by our laboratory database, LDS®. LDS® uses our proprietary scoring system designed to rank testing recommendations based on clinical relevance, medical necessity, and testing indication. Each time an order is placed via the CPOE it automatically includes the appropriate CPT code, diagnostic ICD10 code and LCD/NDC to meet medical necessity for reimbursement.
Instant medical necessity checks
Reduces unnecessary testing
Cost reduction by reducing human capital
Improves Medicare and Insurance compliance
Backed by trusted clinical guidelines
Simple integration with HL7 or FHIR
Lab AI
LabAI streamlines billing claim verification and prior authorization for payers by automatically checking claims for medical necessity and ensuring compliance with Medicare and other insurance policies, resulting in significant cost reductions. LabAI verifies submitted CPT and ICD-10 codes to ensure they align with the associated tests or procedures and meet medical necessity requirements for reimbursement. The system also cross-references Medicare and private payer policies to assist in the accurate and automated approval or denial of claims.
LabAI's customizable proprietary knowledge-based scoring system enables the automation of claim verification and prior authorization processes, further reducing operational costs and enhancing efficiency. LabAI integrates seamlessly via an API, supporting formats such as HL7 through Mirth Connect.
Instant check of every claim for medical necessity
Automated claim verification and prior authorization
Customized report based on claims and denials