Labs are denied for medical necessity, not for coding.
A lab claim is usually coded correctly and denied anyway, because the diagnosis on the order does not support the test. At volume, that is a very large number.
- 97%Coding accuracy on audit
- 50+Specialties covered
- 4.9/5Average client rating
Three ways Laboratory and Pathology claims quietly lose value
Review these issues against the documentation, remittance and policy that applied on the date of service. They can appear as denials or underpayments.
- Ordering diagnosis does not support the test
Coverage rules tie tests to diagnoses. When the order carries a vague code, the claim fails no matter how well the lab performed.
- Panels unbundled or double billed
Component tests inside a panel cannot also be billed individually. Edits catch it, and repeated, it looks deliberate.
- Frequency limits exceeded
Many tests are payable only so often. Repeat testing inside the window is unpaid work already performed.
What we bill for Laboratory and Pathology practices
If something you do is not on this list, ask. We will tell you honestly whether we have the depth for it.
How Laboratory and Pathology accounts are actually run
The worklist connects each claim to its documentation, payer requirements and next follow-up date.
- A laboratory and pathology coder, not a general one
The coder assigned to your account works laboratory and pathology every day. They already know which of your payers do what, and they are watching diagnosis to test matching, panel bundling and frequency limits.
- Charges checked against the note
Before anything goes out, the charge is read against the documentation. A code the note does not support is a recoupment waiting to happen, and in laboratory and pathology it is usually the highest value code on the claim.
- Eligibility and authorization ahead of the visit
Coverage is confirmed and any approval is in place before the service, not discovered afterwards when the work has already been done.
- Denials worked to cause, not just refiled
Every denial is tagged by payer and reason code. When a pattern shows up in your laboratory and pathology claims we change the upstream step so it stops recurring.
- Reporting you can act on
Monthly numbers by procedure family and payer, with the one decision they imply, rather than an export nobody opens.
Included for Laboratory and Pathology practices
- Coders who work laboratory and pathology daily
- Charge review against documentation
- Eligibility and benefit verification
- Prior authorization management
- Denial management by payer and reason code
- Aged A/R worked oldest first
- Patient statements and balance follow up
- Monthly reporting by procedure family
These describe how we run the service. They are commitments about our process, not a guaranteed outcome on any individual claim.
We work inside the system you already use
We agree user permissions, claim queues, reporting access and escalation contacts in your current system before work begins.
Laboratory and Pathology billing across the country
These state guides explain local Medicaid programs and payer administration. They cover general billing requirements, rather than a separate Laboratory and Pathology service in each state.
Arizona payer guideAHCCCS and 7+ plans
Washington payer guideApple Health and 7+ plans
Texas payer guideTexas Medicaid and 8+ plans
New York payer guideNY Medicaid and 8+ plans
California payer guideMedi-Cal and 8+ plans
Ohio payer guideOhio Medicaid and 8+ plans
Florida payer guideFlorida Medicaid and 8+ plansWhat Laboratory and Pathology practices ask
Can you fix diagnosis mismatches before billing?
We flag them before submission and feed the pattern back to the ordering providers, which is the only permanent fix.
Do you handle molecular testing?
Yes. It is high value, heavily reviewed and frequently needs prior authorization.
What about client billing?
Handled separately from patient billing, with its own reconciliation.
Do you manage ABNs?
We set up the workflow. The signature has to happen at the point of service, before the test.
Have a laboratory and pathology coder read your last ninety days
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.