• Clear Orders and Clear Coverage


Whether your lab performs esoteric tests or sends them out, ensuring accurate test reimbursement and simplified coverage remains challenging—orders come from multiple places, payor rules are unclear, and after-the-facet denials can quickly erode the bottom line. Compounding the challenge is growth in molecular diagnostics—more esoteric tests are being ordered, and reimbursement processes aren’t getting easier.

Clear OrdersTM and Clear CoverageTM  level the playing field by making payor rules transparent and ensuring all elements required for reimbursement are in place before an expensive test is performed.

Clear Orders:

  • Aggregates orders regardless of source or format and performs all required medical necessity, ABN and specimen handling checks before a test is performed
  • Routes orders to your LIS or to an appropriate lab for send-outs

Clear Coverage:

  • Automates real-time authorizations between ordering providers, labs and health plans
  • Uses InterQual® Molecular Diagnostics & Imaging Criteria, the gold standard for evidence-based clinical decision support used by hundreds of health plans, to automatically support advanced test choices or recommend alternatives
  • Provides RelayHealth® eligibility checking, payment estimation and other benefit and network coverage data at the point of care

What are the benefits?

  • Drives financial and clinical coverage decision support to point-of-care
  • Lower authorization turnaround from days/ weeks to minutes
  • Incorporates eligibility and other coverage information into the ordering process
  • Hosted web services solution lowers IT burden
  • Supports both clinical lab and imaging activity