AUTOMATED MEDICAL NECESSITY DOCUMENTATION
IT’S ABOUT TIME.
Cellarian automates clinical documentation, prior authorizations, and denials management to help labs make more money in less time with fewer headaches.
Lack of Medical Necessity Documentation is the Most Preventable Cause of Revenue Loss
Labs write off millions of dollars annually.
Drug testing is now a high-volume, low-dollar service. Providers are too overwhelmed to adequately document a patient’s medical necessity reasons for every test ordered. Yet, without this documentation, the revenue is unreachable.
Cellarian solved this problem.
The Challenges
A solution is needed to intelligently automate clinical documentation processes, stay up to date on changes in payer medical necessity and reimbursement guidelines, and accelerate the time from claim denial to successful payment.
Insurance payers overload doctors with excessive medical necessity documentation requirements as a strategy to deny payment for services.
Laboratory Benefit Management process automation by payers uses denials to drive lab behavior towards low-reimbursement codes, since Labs need doctors to provide proper clinical documentation to get paid.
Doctors don’t perceive benefit from the cost of adding clinical documentation, so they rarely do it, resulting in denied payments and significant revenue loss that labs cannot recover without documentation.
Denied claims are expensive to appeal, so labs are forced to either write off on average 20% of monthly accounts receivable or spend more money/staff resources trying to fight the denials which are often never paid due to lack of documentation. These additional expenses further decrease monthly net profits.
The Cellarian Solution
Using data sources such as Laboratory Information Systems and Electronic Health Records, Cellarian automates patient-specific clinical documentation, claim appeals, and prior authorizations to help labs reduce denial management costs, streamline operational efficiency, and collect more revenue so they can focus on growth, without adding any work on doctors and remaining in compliance with HIPAA regulations.
By automatically searching and integrating updated payer medical necessity policies Cellarian ensures maximum revenue capture and compliance with payer guidelines, matching the payers’ Laboratory Benefit Management and ensuring the maximum reimbursement compliantly allowed.
Our scalable technology platform is rapidly adaptable to any diagnostic lab service line with clinical documentation requirements, increasing claim denials, or time-consuming prior authorizations, with the greatest ROI delivered at scale.
