Claim Editing

Claim Editing and Pricing

Our claim editing and pricing technology interfaces with health plan claim systems in an industry-standard HIPAA compliant format.  We edit claims based on health plan-approved clinical, quality, administrative, and pricing policies.

Claim edits perform many checks including confirming test authorization, quality attributes of the laboratories, evidence of clinical appropriateness, coding appropriateness, preferred pricing arrangements, and the presence of other important information including CLIA number and ordering provider NPI.


Our Healthcare Claim Editing Technology

BeaconLBS offers advanced claims software that provides highly accurate claims editing and pricing and is interfaced with health plan claim systems via an API or 837 standard transactions. Claims are adjudicated in the health plan claim environment and the provider claim submission process remains unchanged. 

Our streamlined claims editing technology accelerates adjudication and increases payment integrity by reducing errors and optimizing compliance with clinical, administrative and payment policies. With our software, you’ll get fast and precise, results without the need for manual intervention. 

Health plans can customize their claim edits using our proprietary library of extensive clinical, administrative, and pricing edits which will help you lower costs and significantly reducing fraud, waste and abuse. You also have the flexibility to configure responses to different types of edits for more efficient workflows.

Labs-of-Choice® Preferred Pricing

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 CAP accreditation, performing 2nd reads on pathology specimens, subspecialty reads on complex pathology specimens, and maintaining electronic ordering and test-resulting capabilities

Contact Beacon for Healthcare Claim Editing and Pricing

Beacon provides state-of-the-art technology to streamline the claim editing process and ensure precise and accurate results.