Beacon Laboratory Benefit Solutions, Inc. (BLBS) is an innovator and nationally recognized premier provider of lab benefit management technology solutions to health and managed care companies. Labs that are a part of our Laboratory Benefit Management Program (LBM) are distinguished among their peers as those that adhere to specific high-quality measures, promote efficiency, and provide cost-effective services.
All labs that are part of the Laboratory Benefit Management program must meet quality standards, appropriate to the level of testing they offer, in order to be eligible for payment. Depending on the complexity of the testing offered, this could be as simple as the lab having the ability to receive orders electronically or provide electronic results. However, for more complex testing, the lab might need to have College of American Pathologists (CAP) or Joint Commission (JCAHO) accreditation and, in some cases, have appropriate subspecialists on their teams to handle test reads for new malignancies or atypical cases.
For labs that participate in a health plan’s active LBM, as in Florida, there are also other requirements for successful claims adjudication. Being a Lab-of-Choice™ can result in a lab receiving minimal claim denials, greater exposure and increased order volume:
- Prominent Promotion – The Physician Decision Support platform (PDS®), the vital technology that participating referring providers use to fulfill program requirements, displays Labs-of-Choice™ at the top of the lab selection list. Other health plan participating labs are listed alphabetically on a different tab. The PDS® notifies providers when they have initiated a request from a lab that doesn’t meet the health plan’s quality standards. In this way, the PDS technology promotes Labs-of-Choice™ to ordering physicians as labs with confirmed quality and cost efficiency.
- Integration – Labs-of-Choice™ have the opportunity to integrate the PDS® directly with their online ordering system. This eliminates eligibility checks for the lab’s client referring providers and makes compliance for covered tests virtually automatic with the health plan’s Advanced Notification (AN) or Prior Authorization (PA). The process helps to make sure that claims are not denied for the absence of notification or authorization when orders are placed through the online system by automatically guiding the provider and completing this process as part of the order.
- Automated Reminders – Through the Physician Decision Support Queue (PDS-Q) process, Labs-of-Choice™ are eligible to set up an automated electronic flat file transfer to BLBS daily with all health plan orders. From that file, BLBS identifies eligible health plan members for whom tests which are managed under the LBM program were ordered (Decision Support Tests) but for which notification or authorization was not completed. BLBS sends an email notifications to the ordering provider’s facility alerting them that there are notification or authorization cases to be completed. When the ordering provider logs in to their PDS-Q inbox, requests can be completed simply and quickly. The PDS-Q process is provided as a free option exclusively for Labs-of-Choice™ and is used successfully by many, with most reporting ordering providers like it, and there are drops in administrative claim denials.
- Pricing Comparisons – Currently, in PDS®, referring providers are able to view relative pricing comparisons between Labs-of-Choice™ and other labs as a way to better evaluate the potential out-of-pocket expenses for their patients. Because Labs-of-Choice™ are committed to efficient and cost-effective laboratory testing, their pricing is generally lower than other health plan participating labs. This cost-effective promotion is another way to increase their reach and volume of lab orders.
- More Revenue Options – Labs-of-Choice™ have the opportunity to increase their revenue above and beyond their negotiated fee-for-service contract terms by participating in additional BLBS programs. Contact us to learn more.
If you are interested in more information about becoming a Lab-of-Choice™, please call 800-377-8809 or email firstname.lastname@example.org. We would be happy to have one of our team members reach out and answer your questions.
Insights / February 20, 2019 / by beaconlbs
BeaconLBS works with our health plan, employer and accountable care organization (ACO) partners to use evidence-based policies and guide lab test benefit management. Read about our four steps below.