Lab Policy Management

Health Plan Branded Solutions Matter

BeaconLBS is a laboratory benefits solutions company that provides health plans with a branded approach to improve the quality and cost of lab testing. Our solutions, processes, and technology become the health plan’s solutions, processes, and technology, customized and branded to be seamlessly integrated into a health plan’s portfolio of care management solutions.

Doctor in lab coat looking at a clipboard

We power health plans with five key solutions:

Prior Authorization and Advance Notification

Integrated with existing physician workflows
5-10x faster than current prior authorization methods
Digitized cases enabling 30-second MD reviews

Policy Management

143 evidence-based clinical, quality, and administrative policies
A distinguished 16-member clinical advisory team

Preferred Lab Networks

Electronic integrations, pre-and post-test ordering
Preferred test pricing
Quality testing, including CAP-accreditation, path 2nd reads and subspecialty review, electronic test ordering & results

Claim Editing

Sub-second claim edit review
Claims adjudicated in health plan environment

Test Identification and Mapping

95% of U.S. labs registered and mapped
250+K tests identified and mapped

Integration Means Faster and Higher Quality Testing

Importantly, our health plan branded solutions are integrated in existing lab and EHR test ordering workflows providing physicians with convenient and immediate access to the latest evidence-based clinical guidelines to support test-ordering and the completion of prior authorization and advance notification processes.

Tests meeting clinical guidelines can be immediately approved thereby eliminating any wait-time hassle factor for patients and physicians. And digitized cases needing medical director review can generally be completed in hours, rather than days.

Speak With An Expert

Effective Policy Management Means Higher Quality Test Ordering and Preferred Lab Selection

Based on claim analysis, clinical knowledge, actuarial expertise, and business acumen, our policy team determines the policies needed to support the health plan’s laboratory test management mission and strategy. We develop a “test formulary” that will have the greatest clinical and financial impact with the least amount of tests and we research the clinical literature for evidence-based guidelines to support the efficacious use of these tests. Our policy and expert clinical advisory team review, edit, and finalize policies and clinical algorithms prior to presentation to the health plan’s clinical advisory group for adoption as their own.

This process has resulted in a nearly 2-fold improvement in physician adherence to evidence-based guidelines when ordering tests and a 25+% improvement in physician selection of health plan preferred labs, defined as labs with preferred pricing and quality, i.e. CAP-accreditation, path 2nd reads, and subspecialty review, electronic test ordering & results.

Test Identification and Mapping Means High Quality Claim Editing

With over 20K tests in the market today, many defined with unique CPT code combinations, it’s important to be able to accurately identify billed tests at the point-of-claim-adjudication in order to accurately:

Apply claim and preferred pricing edits
Identify billed tests subject to prior authorization and advance notification
Identify unproven tests ineligible for payment

Two people at a doctor's office speaking to a doctor with a clipboard

Savings Matter

We can save a health plan up to 20% on the overall outpatient lab testing expenditures, including par and nonpar costs, billed from the outpatient hospital, physician office, and independent labs settings. Importantly, while testing costs represent only 2% to 3% of total healthcare costs, test results inform 75% of treatment decisions. Therefore, selecting the right test and right lab matters in lowering test and overall patient care costs.

Our program resulted in improved physician adherence to evidence-based guidelines by nearly 2-fold while improving appropriate referrals to high-quality cost-efficient labs by 25+%.

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