Clientele automates every stage of laboratory revenue cycle management: test ordering, medical necessity validation, panel and CPT sequencing, NCD/LCD coverage rules, provider verification and molecular authorization, through one diagnostic intelligence network.
Each testing line carries its own coverage rules, documentation and coding logic. Select a node to see what Clientele validates before the claim releases.
Provider order to reimbursement, tracked as one continuous data pipeline over the accession record.
Panel bundling, CPT sequencing, diagnosis-to-test mapping, NCD/LCD policy, provider validation and molecular authorization, each module scored, each decision traceable to the rule that produced it.
Component tests rolled into the correct comprehensive code, separations justified.
Line order, units and modifiers assembled the way payer edits expect.
Submitted diagnosis matched to the test ordered, not the test performed by habit.
Coverage determinations applied by jurisdiction and payer policy language.
Ordering provider validity, enrollment and privileges verified at accession.
Molecular and genetic approvals monitored from submission to confirmation.
Final gate: every validation cleared before the claim is released.
One board across the lab and the revenue team: incoming orders, coverage validation, authorization and provider queues, denials and appeals.
An intelligence layer that reads the order, the diagnosis and the payer policy together, then returns a coded, covered, submission-ready claim.
Where laboratories see movement: fewer medical-necessity denials, fewer panel coding errors, cleaner authorizations and faster A/R turnaround.
Select a service line to see its documentation, coverage, coding and automation profile.
NCD/LCD policy matched to assay and indication, with authorization tracked to approval.
Panel bundling errors were our largest write-off category. They were understood, mapped and closed within the first quarter.
Molecular authorizations now reach approval before the specimen is resulted, instead of after a denial.
They read the LCD the way the payer reads it. That distinction changed our medical-necessity denial rate.
Anything else, a Laboratory RCM specialist will walk your team through it directly.
Each order is tested against payer coverage policy for the specific test: the submitted diagnosis must support the assay, the intent must be clear, and frequency limits must be satisfied. Orders that cannot be supported are surfaced to the lab before the claim goes out.
Component tests that belong to a comprehensive panel are rolled into the correct code rather than billed individually, and legitimately separate tests are kept separate with the documentation that justifies them. This removes the most common source of laboratory coding rework.
Yes. National and local coverage determinations are applied by jurisdiction and payer, including policy-specific diagnosis lists and documentation requirements, so coverage is evaluated the way the policy actually reads.
Molecular and hereditary panels are routed through authorization tracking: criteria assembled from the clinical record, submission monitored, and approval confirmed before the claim releases. Expiring approvals surface ahead of lapse.
NPI validity, enrollment status and ordering privileges are checked at accession. Invalid or non-enrolled ordering providers are flagged at intake instead of returning weeks later as a rejection.
We integrate with the systems your laboratory already runs (LIS, billing platform and clearinghouse) and read from your existing requisition flow. No change to how orders arrive is required to begin.
Presumptive and definitive testing are evaluated against documented treatment intent, with drug class counts and per-day unit limits enforced, which is where most toxicology denials originate.
Accession-level auditability plus operational reporting on medical-necessity accuracy, panel coding accuracy, authorization success, provider validation, clean claim rate and A/R turnaround, segmented by test line, client and payer.
The intelligent bridge between care delivery and revenue success: coverage-aware coding, defensible medical necessity and authorization visibility across every accession.
