Beacon has numerous lab benefit management program services across the point-of-test order to point-of-claim adjudication spectrum to improve testing quality while lowering testing costs. Our solutions include:
Savings up to 20%
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+%.
Prior authorization is an essential tool for providing the best patient care while reducing waste. However, the heavy volume of prior authorization transactions can be difficult for physicians and doctor’s offices to manage, and a lack of automation makes the process tedious and time-consuming.
With our technology, the prior authorization process is faster and easier. Our Physician Decision Support® (PDS) system collects clinical information from providers and submits the request for approval in real-time. This automated process reduces hours or even days of work down to a matter of seconds while also providing more accurate determinations.
During the health plan claim adjudication process, laboratory-submitted bills are passed by the health plan through our editing system through an API or 837-transaction. Our system performs 143 checks including the presence of authorization when appropriate, the quality metrics of the rendering laboratory, evidence of clinical appropriateness, CPT-code billing appropriateness, application of preferred pricing arrangements, and the presence of important information including CLIA number and ordering provider NPI. The edits reflect the clinical and administrative policies that are developed and maintained by Beacon and adopted and approved by the health plan.
With our advanced claims editing software, you’ll get fast, straightforward, and meaningful results.
National Lab Network
Our forty-nine Labs-of-Choice™ are distinguished by their quality attributes, preferred pricing, electronic interfaces with physician practices, and market presence and penetration, as they represent approximately 40% of all outpatient lab testing in the U.S. Each lab is committed to providing affordable testing and adhering to quality lab practices, including:
- College of American Pathologists (CAP) certification.
- Electronic results and ordering.
- Subspecialty review of a complex pathology.
- Second reads on pathology.
National Electronic Health Record (EHR) Network
BeaconLBS has extensive experience integrating our laboratory management technology with 14 EHRs which makes the prior authorization process more convenient and faster for physicians as we incorporated prior auths in the standard electronic test ordering process. Physicians can complete prior authorizations in their existing workflows in 30-seconds, which is much faster than traditional prior authorization processes which can take up to 10-minutes to complete.
Our EHR integrations conveniently present physicians with clinical algorithms that support test and lab-facility selection decisions which results in lower test costs and high-quality test selection.
Beacon has registered and test-mapped 90+% of laboratories in the United States and mapped their tests to laboratory benefit management policies. Through this system, we’ve built the largest lab test mapping database in the country.
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
Our proprietary national lab testing mapping database makes it possible for health plans to systematically and accurately identify billed tests at the point of adjudication.
Point-of-Order and Point-of-Adjudication Technologies
Beacon’s technology platform provides health plans with a wide array of solutions across the point-of-order (POC) to point-of-adjudication (POA) lab test management spectrum, including:
- POC Advance Notification
- POC Prior Authorization
- POC Test and Lab Selection Decision Support
- POC Test Pricing
- POC Benefit information (e.g. drug testing benefit accumulators)
- POA Clinical, Administrative, Quality and Pricing edits (143)
- POA Test Identification Precision via Test Mapping
We provide physicians a wide array of convenient access points to our POC technology solutions, including the following access points:
- Beacon’s cloud-based POC applications
- Beacon’s integrations with 49-labs
- Beacon’s integrations with 14 EHRs
To learn more about our patient care management services, contact us today.