One order, from entry to a clean claim
A synthetic Medicare order, step by step. VektorDx reads your lab system, the scanned requisition and the payer's eligibility answer. It never changes the order, never suggests a diagnosis code, and never submits a claim. People make every change.
Staff enter the order as they do today
Nothing changes at accessioning. The requisition is scanned and attached to the order the way your lab already does it.
VektorDx picks up the new order
Every 15 minutes, new orders are read from your lab system through a read-only connection: tests with CPT codes and units, diagnosis codes, ordering provider, clinic, insurance, and the patient's prior orders.
AI reads the scanned requisition
Only four regions are read: the insurance card or face sheet, the diagnosis box, the signature block and, on toxicology orders, the drugs requested. Your lab system's own printout page is skipped. On TEST-1044 the card shows a Medicare Advantage plan, but the order was entered as traditional Medicare.
Eligibility is checked with the payer
A real-time eligibility check goes through a clearinghouse. Medicare's answer shows Part B dates, Medicare Advantage enrollment, other insurers that pay first, and hospice or QMB status. For TEST-1044 it confirms the Medicare Advantage plan named on the card.
If the payer doesn't answer, the order is marked unverified. A missing answer is never treated as missing coverage.
Rules are applied and the order is graded
Each rule in the Medicare pack runs against the order, the scan read and the eligibility response. TEST-1044 gets one finding: "Entered as Medicare; patient is enrolled in a Medicare Advantage plan. Bill the plan named." The finding shows the card region, the eligibility response and the rule's source.
The finding goes to the right person
Each finding has a fix owner: accessioning, client services, billing or the ordering clinic. A wrong plan goes to accessioning. A missing signed visit note goes to the clinic through a secure link.
Staff correct the order; it's checked again
Accessioning updates the payer in the lab system. VektorDx re-reads the order, the rules pass, and the grade moves to Ready.
The claim goes to the right payer the first time
Your billing system sends the claim as usual, now to the plan that will pay it. Later, paid and denied outcomes are joined to each order's findings, so the rules and the future payment score can be measured against what actually happened.
What VektorDx reads
- New orders in your lab system, with their attached scanned requisitions (read-only)
- The patient's prior orders, for frequency limits
- Eligibility responses from the payer, through a clearinghouse
- Public CMS and contractor rules: NCDs, LCDs, unit limits, ICD-10-CM, the ordering and referring file
What it never does
- Change an order in your lab system
- Choose or suggest a diagnosis code. That is the ordering provider's decision
- Submit, correct or hold a claim
- Send patient data to any model not covered by a Business Associate Agreement
More examples from the demo
- Vitamin D (82306) with a screening diagnosis only: ABN needed under LCD L34914
- Urine drug test with no drugs named, or a standing order: flagged under LCD L35006
- Ordering provider not enrolled to order for Medicare: fix before billing
TEST-1044 is a synthetic order. Times are illustrative, not measured results.