Catch the denial at the order, not the claim.
Order QA grades every order your staff enter, before the claim is sent. It reads the order from your lab system and its scanned requisition, checks eligibility with the payer, and applies that payer's rules. Medicare is the pilot; checks for all major insurance payers follow. Every finding shows its evidence, the CMS source and who should fix it.
Three sources, one rule pack, one grade
Each new order is checked against everything that can be known about it on the day it's entered. AI reads the paper; every finding is decided by a rule with a published source.
The order
Accession, collection date, tests with CPT codes and units, ICD-10 codes, ordering provider NPI, clinic, primary and secondary insurance, and the patient's prior orders for frequency limits. Read-only.
The requisition
AI reads four things from the scanned requisition: the insurance card or face sheet, the diagnosis box, the signature block, and the drug list on a toxicology order.
Eligibility
A real-time eligibility check through a clearinghouse: is coverage active on the date of service, which plan is it really, and is there other coverage nobody entered?
Rules with a source and an effective date
Each payer's published policies are turned into rules, each with the exact quote and source, and a billing or coding expert agrees every rule before it runs. Medicare is the pilot: Medicare ID, plan type, ordering provider enrollment, the lab NCDs, unit limits, the drug-testing and vitamin LCDs, signatures, ABNs and timely filing. Rule packs for the other major payers follow. See the Medicare rules.
A grade, the findings, the evidence and who fixes it
The evidence is the order field, the region of the scan and the rule's source link. The fix goes to the right person: accessioning, client services, billing, or the ordering clinic. Follow one order.
Every order gets one of four grades
Grades come from rules, not guesses. An eligibility check that gets no answer marks the order unverified, never inactive.
Order, scan and eligibility agree, and every rule that applies has passed.
Something staff or the clinic can correct before the claim goes out.
The test is likely not covered for this diagnosis, so an Advance Beneficiary Notice is needed.
The claim will very likely be denied as the order stands.
The clinic fixes it from a single-click link
When only the ordering clinic can supply what's missing, VektorDx sends the practice one secure link per location, before the claim is submitted. It uploads the signed visit note or a photo of the insurance card. AI checks that the document is for the right patient and contains what was asked, then files it with the order in your lab system.
Findings by order, payer and clinic
Fed straight from your lab system. Nothing is installed and no workflow changes for accessioning.
| View | What it shows |
|---|---|
| Orders list | Each new order with its readiness grade, filtered by grade, payer, clinic or fix owner |
| Order detail | Each finding with its evidence: the order field, the scan region, the eligibility response and the rule's source link and effective date |
| Payer summary | Grades and findings by payer and plan type, including Medicare Advantage entered as Medicare |
| Clinic summary | Findings by clinic, ranked by dollars at stake, with clinic response times |
Next: a payment score per order. It appears for a lab only after it has been calibrated on that lab's own paid and denied claims, with its measured accuracy shown beside it.
See yesterday's orders, graded
We'll walk through the dashboard on synthetic orders, and talk about what connecting your lab system involves.