Platform
Every step between an order and a paid claim.
LABDATA 360° is a single platform — not a stack of point tools held together by spreadsheets. Below is the detail on the problems we solve, the capabilities we built, and how they work together to turn orders into revenue.
Built on standards labs already trust
- HIPAA-aligned
- MFA / AAL2
- Standards-based
- Cloud-native
- Encrypted in transit & at rest
- Audit-logged
What we actually solve
Built to kill the four most expensive problems in specialty-lab billing.
Every capability in LABDATA 360° exists because it fixes a specific, recurring failure mode we see at toxicology, molecular, reference, and pathology labs. These are the four we hear most.
Dirty intake data
Orders that can't convert to clean claims.
CO-16 — "claim/service lacks information" — is consistently among the most frequent denial codes in outpatient lab billing. Missing ZIPs, apartment numbers that don't exist, and patient names that don't match the member ID all get caught downstream, weeks later, by a biller. We catch them at intake.
How we solve it
- Live address verification with geocoded validation
- Patient-name safeguards that flag mismatches before submission
- Insurance card capture (front + back) with clearing-house-agnostic payer matching
- Name aliases let organizations pick familiar names while billing gets the identifiers claims require
Preventable denials
The denial was decided before the sample was drawn.
The CMS CERT program puts lab tests at a 27.2% improper payment rate, and more than 80% of those errors trace to clinical documentation, not coding. LABDATA 360° defends against denial in three layers at intake: syntactic guardrails on the order itself, provider-authorized, AI-generated medical necessity documentation on every insurance claim, and proactive prior authorization before the specimen ships.
How we solve it
- Syntactic guardrails — wrong-year dates, PECOS, credential restrictions, duplicate analytes, ABN
- JustifAI — individualized medical necessity narrative on every insurance order
- AuthorizeAI — nightly batch scan drafts prior authorizations before the specimen ships
- Passive PA indicators at order entry — no interruption to the clerk
Fragmented patient identity
One patient. One record. Across every organization you serve.
Duplicate patient records split clinical history, cause results to land in the wrong chart, inflate patient counts, and create downstream billing errors that are expensive to unwind. LABDATA 360° finds duplicates the day they're created — not the year you discover them.
How we solve it
- Exact (SSN), high-confidence (name + DOB), and medium-confidence (name + phone) matching
- Audited deactivate → archive or permanent-delete workflow
- Row-level hints that surface the safer record to keep
- Full audit trail on every merge
Vendor sprawl
The stack you were paying four vendors to almost integrate.
The typical specialty lab runs separate tools for order portal, HL7 engine, insurance verification, results delivery, and billing handoff. Every seam between them is a place information falls on the floor — and every vendor adds contract, integration, and HIPAA audit surface area.
How we solve it
- Order entry, interoperability (HL7 and FHIR), insurance, results, and billing — one login
- Real-time chat support, automated patient scheduling, and electronic payment with Stripe
- One HIPAA audit trail, not five
- Built for toxicology, molecular, reference, and pathology from the first commit
What you get
Six pillars. One platform.
Everything a specialty lab needs to take an order, validate it, send it, return results, and get paid — without taping together five different vendors.
Order Entry & QC
Order-to-lab in minutes with built-in safeguards.
A guided intake flow validates dates, providers, insurance, and specimen-to-test compatibility before an order ever leaves the organization. The Order Feed gives lab staff one queue to monitor, flag, and triage everything across every customer in real time.
- Wrong-year detection and date-range checks
- PECOS enrollment + credential restriction enforcement
- Duplicate-analyte prevention at selection
- Lab-wide Order Feed with proactive flagging
Results Delivery
PDFs, flags, and abnormal-only views — ready the moment results drop.
Results stream into the platform from your LIS over HL7, are normalized against reference ranges, and surface in clean PDF reports with high/low/abnormal flags. Organizations get focused abnormal-only views; clinicians see the full report.
- Real-time HL7 ORU ingestion from your LIS
- Per-organization access with abnormal-only filters
- PDF reports branded to your laboratory
- Critical-result acknowledgment workflow
Insurance & Billing
Clearing-house agnostic. Alias-mapped. PECOS-aware.
Organizations select insurance using the names they already know. The platform maps those selections to the payer IDs and identifiers your clearing house requires — no lock-in to a single directory or vendor list. PECOS enrollment and credential restrictions are checked up-front so denials never originate at the order step.
- Clearing-house-agnostic payer matching — works with any clearing house
- Name aliases — organizations see familiar names, billing gets what claims require
- Insurance card image capture (front + back)
- Client invoicing with electronic payment (Stripe) and paper/check fallback
- Patient Pay, Client Bill, and Workers' Comp routing
Interoperability
Secure, standardized data exchange between your lab and every system it touches.
Orders and results flow reliably between your LIS, your clearing house, and every healthcare organization you serve — encrypted, audit-trailed, and aligned with federal interoperability requirements. Legacy HL7 keeps you connected to the systems you run today; FHIR support positions you for where CMS is taking the industry.
- Legacy HL7 support for the LIS you run today
- FHIR-ready for CMS Promoting Interoperability requirements
- Encrypted transport with retry and full audit trail
- Routine batch and immediate STAT delivery
AI Test Search
Search “opioid” — get the right tests back, even if your catalog calls them Analgesics.
Semantic search over your test catalog understands synonyms, drug classes, and clinical intent. Clinic staff find the right panels in one query instead of hunting through a tree, and your catalog stays in your laboratory's preferred terminology.
- Semantic matching across synonyms and drug classes
- Drug-class filter chips for fast narrowing
- Catalog stays in your laboratory's terminology
- No tagging or maintenance burden on lab staff
Security & Compliance
HIPAA, MFA/AAL2, encryption in transit & at rest, full audit trails.
Built on a modern, audited stack with HIPAA-aligned controls. Multi-factor authentication is enforced at the database level via AAL2 row-level security, every PHI access is logged, and OAuth/SSO is supported. The platform was designed for protected health information from the first commit.
- MFA/AAL2 enforcement on all PHI tables
- TLS in transit, AES-256 at rest
- Complete audit trail of every PHI access
- Role-based access groups + organizational hierarchy
Order entry & QC
One queue. Every order. Caught before it costs you.
The Order Feed gives lab staff a single, real-time view of every order across every customer. Wrong-year typos, missing PECOS enrollment, duplicate analytes, and unverified insurance get caught at intake — long before lab work begins or claims get denied.
- Wrong-year detection and 7-day date-range guardrails
- PECOS enrollment + credential restriction enforcement
- Duplicate-analyte prevention at test selection
- Lab-wide flagging with notes for proactive follow-up
Results delivery
Results that arrive ready to act on.
Inbound HL7 ORU messages stream from your LIS into LABDATA 360°, are normalized against reference ranges, and surface as branded PDF reports with high/low/abnormal flags. Organizations get focused abnormal-only views; clinicians always see the full report.
- Real-time HL7 ORU ingestion from your LIS
- Per-organization access with abnormal-only filters
- Critical-result acknowledgment workflow
- PDF reports branded to your laboratory
Interoperability
Your lab's data flows where it needs to, when it needs to.
Outbound orders and inbound results travel over secure, encrypted channels with retries and full audit trails. Legacy HL7 keeps you connected to the LIS you run today; FHIR support positions you for CMS Promoting Interoperability requirements. Routine orders batch on schedule; STAT orders transmit immediately.
- Legacy HL7 support for the systems you run today
- FHIR-ready for CMS Promoting Interoperability requirements
- Encrypted transport with retry and acknowledgement
- Scheduled batch delivery, immediate STAT
AI at the edge of the claim
Two AI capabilities that fight denials before they happen.
The RCM industry built itself around writing appeal letters after denial. We generate the justification before submission, and we draft the prior authorization before the specimen ships. CAQH pegs industry-wide denial rework at $8.6B per year — JustifAI and AuthorizeAI exist to make that work unnecessary.
- Lab test CERT improper-payment error rate
27.2%
Lab test CERT improper-payment error rate
- Annual lab share of Medicare Part B improper payments
$1.2B
Annual lab share of Medicare Part B improper payments
- Per physician per week spent on prior auth
13 hrs
Per physician per week spent on prior auth
- Organizations ready for CMS's Jan 2027 ePA mandate
9%
Organizations ready for CMS's Jan 2027 ePA mandate
JustifAI
Medical necessity, written as the order is placed.
The #1 cause of lab denials is insufficient medical necessity documentation — not incorrect coding. Medicare LCDs prohibit boilerplate language and require individualized justification for every test, on every date, for every patient. JustifAI generates that narrative automatically at the Review & Submit step, using the patient's diagnoses, medications, prior abnormal results, and testing history.
How it works
- Runs at the Review & Submit step of every insurance-billed order
- Pulls diagnoses, medications, prior abnormal results, testing history
- 2–3 paragraph narrative tailored to the specific encounter
- Stored PDF with document ID, timestamp, and model version for audit
- Provider opt-in, non-blocking by design
AuthorizeAI
Prior auth, handled before the specimen ships.
Labs lose revenue to retroactive PA rejections they never saw coming. AuthorizeAI inverts the workflow: billing staff configure PA rules at the payer level, a nightly batch scan finds patients who need authorization, and AI drafts the clinical justification for each submission. The order-entry clerk sees a quiet "PA on file / pending / needed" indicator — never a blocking dialog.
How it works
- Three-tier payer rule engine — always, frequency-based, or code-specific
- Nightly batch scan drafts PAs before the specimen ships
- AI narrative tuned for payer UM reviewers
- Passive indicators at order entry — no clerk interruption
- On the glide path to the CMS-0057-F FHIR ePA mandate (Jan 2027)
Sources: CMS CERT 2024 report, CAQH Index, AMA 2024 Prior Auth Physician Survey, CMS-0057-F Interoperability & Prior Authorization Final Rule.
See LABDATA 360° on a real workflow.
Tell us a little about your laboratory and we’ll provision a guided demo. No credit card, no contract — just a 30-minute working session with our team.