In the competitive and fast-paced world of diagnostics, laboratories and Laboratory Information Systems (LIS) are under constant pressure to deliver timely results while maintaining financial stability. One of the most significant challenges these stakeholders face is managing claim denials and ensuring a seamless revenue cycle.
With EligifAI, an advanced eligibility verification solution, labs and LIS systems can integrate real-time insurance verification, streamline billing, and reduce operational costs.
How eligibility verification benefits
1. Reduced Claim Denials
Claim rejections due to incomplete or outdated insurance information can cost labs tens of thousands annually. EligifAI’s real-time verification reduces denials by up to 35%, ensuring cleaner claims from the start.
Common Eligibility-Related Denials Eliminated with EligifAI
- Code 22: This care may be covered by another payer per coordination of benefits.
- Code 31: Patient cannot be identified as our insured.
- Code 35: Lifetime benefit maximum has been reached.
- Code 42: Charges exceed our fee schedule or maximum allowable amount.
- Code 125: Submission/billing error.
- Code 170: Payment is denied when performed/billed by this type of provider.
2. Improved Cash Flow
By verifying insurance upfront, EligifAI helps labs avoid delays in payment cycles. Labs using EligifAI have reported a 25% faster payment cycle, boosting operational cash flow.
3. Cost Savings
Automation through EligifAI reduces manual verification efforts by 40%, saving administrative costs and improving staff efficiency.
4. Enhanced Patient Satisfaction
Unexpected billing issues frustrate patients and lead to dissatisfaction. EligifAI’s precise eligibility checks ensure that patients receive transparent, accurate cost information before services are rendered.
Case Study: Success with EligifAI
A regional diagnostic lab integrated EligifAI into its LIS workflow. Within six months, the lab achieved:
- 40% Fewer Claim Denials: Insurance errors were flagged and corrected in real time.
- 20% Increase in Revenue: Timely eligibility checks minimized delays and denials.
- Significant Cost Reduction: Administrative overhead decreased by approximately $50,000 annually.
Revenue Cycle Management for the Future
Eligibility verification isn’t just an operational task—it’s a strategic necessity. By partnering with EligifAI, lab and LIS system owners can leverage advanced technology to:
- Decrease the cost to collect.
- Improve revenue predictability.
- Reduce operational complexity.
- Gain peace of mind knowing their processes are efficient and compliant.
Title: How Eligibility Verification with EligifAI Transforms Revenue Cycle Management for Labs and LIS Systems
In the competitive and fast-paced world of diagnostics, laboratories and Laboratory Information Systems (LIS) are under constant pressure to deliver timely results while maintaining financial stability. One of the most significant challenges these stakeholders face is managing claim denials and ensuring a seamless revenue cycle.
With EligifAI, an advanced eligibility verification solution, labs and LIS systems can integrate real-time insurance verification, streamline billing, and reduce operational costs. This article explores why eligibility verification is crucial for labs and how EligifAI provides the edge they need.
Why Eligibility Verification Matters for Labs and LIS Systems
Insurance eligibility verification ensures a patient’s insurance details are accurate and valid before providing services. This simple yet vital step can revolutionize the revenue cycle by reducing denials, improving cash flow, and minimizing billing errors.
Key Statistics for Lab Owners:
- 30% of medical claims are denied on the first submission, with 90% being preventable through proper eligibility checks.
- Automated verification systems reduce billing errors by 27%, saving labs both time and money.
- Labs utilizing real-time verification can decrease accounts receivable days by up to 15%, accelerating revenue collection.
EligifAI: Tailored Solutions for Labs and LIS Systems
EligifAI is designed specifically for lab owners, LIS providers, and healthcare system leaders. With real-time API integration and a user-friendly portal, EligifAI makes eligibility verification effortless, ensuring labs can focus on diagnostics rather than administrative hurdles.
How EligifAI Works:
- Real-Time Integration: Labs can send a JSON request or HL7/EDI files to EligifAI’s API. The response includes a secure, white-label-ready HTML page, eliminating the need for additional development.
- Comprehensive Payer Coverage: Access eligibility information from thousands of payers in one portal.
- Actionable Insights: Detailed responses help labs verify coverage, co-pays, deductibles, and potential restrictions instantly.
Ready to Transform Your Lab’s Revenue Cycle Management?
Discover how EligifAI can optimize your operations and enhance your financial performance. Visit EligifAI.com today to learn more about our eligibility verification solutions for labs and LIS systems.