Lab AI · Claims analytics
Catch denials before your claims go out
Lab AI checks every claim’s CPT and ICD-10 codes against Medicare and private payer policy, suggests a fix when one fails, and shows where your denials come from. Use it at two points in your workflow:
At order entry
Real-time medical necessity checks on orders as they arrive, whether they come through your EMR-to-LIS interface or are entered manually by your laboratory.
Before billing
Check and correct billing claims before they’re submitted, to avoid denials.
Connects to the data you already have
- HTTP API
- HL7 via Mirth Connect
- Medicare LCD / NCD
- Private payer policies
Walkthrough
Lab Necessity App
The Problem
Denials are cheapest to fix before the claim goes out
Billing teams usually find a medical necessity problem when the denial arrives, weeks later. Fixing it means chasing the provider for a new code, resubmitting and waiting again, and some claims are never recovered.
Lab AI checks orders for medical necessity as they arrive, checks claims again before submission, recommends corrections, and shows where denials come from.
11.9%
of 374,423 lab test claims used a diagnosis code that Medicare never covers.
Source: (Leblow, Hamill & Beqaj, 2019)
12.8%
of the same claims didn’t meet Medicare’s coverage rules for the test.
Source: (Leblow, Hamill & Beqaj, 2019)
10.2%
of one payer’s 294,870 lab claims used a diagnosis code that is always denied.
Source: (Leblow, Hamill & Beqaj, 2019)
How It Works
Fewer denials in four steps
Catch medical necessity problems when the order arrives and again before the claim goes out, and see why denials happen.
Step 1: Connect your data
Send claims and orders through our API, or as HL7 through Mirth Connect.
Step 2: Check orders and claims
Orders are checked in real time as they arrive from your EMR or manual entry, and claims again before billing, against the test, its codes, and Medicare and private payer rules.
Step 3: Fix before you submit
For any claim that won’t pass, Lab AI suggests a better test or code.
Step 4: Stop repeat denials
Dashboards and reports show where denials come from, by payer and by test.
What Lab AI does
Every claim checked, every denial explained
Lab AI works on your own orders and claims: at order entry, before submission, and after.
Real-time order checks
Orders arriving through your EMR-to-LIS interface, or entered manually by your lab, are checked for medical necessity as they come in.
Pre-submission claim checks
Before billing, each claim’s CPT and ICD-10 codes are checked against Medicare LCD/NCD and private payer policies, with a suggested test or code fix when one won’t pass.
Test utilization reports
Spot low-scoring and unnecessary tests, and see which ordering patterns drive cost.
Denial and coding analysis
Track denials by payer and test, and find the most common invalid ICD-10 codes and unrecognized CPT codes.
Cost and reimbursement dashboards
Compare cost per test with what was paid, and filter every view by year and month.
Reports for labs and practices
Customized reports explain what went wrong and what to order or code instead, so the same denial doesn’t repeat.
Sample Output
A Lab AI analytics dashboard
A sample of the Lab AI reports dashboard, filterable by year and month: total orders and denials, why claims were denied, the most denied CPT codes, invalid ICD-10 codes, LDS® scores, cost per test, and LCD/NCD results.
All figures are sample data for illustration only.
Who It’s For
Who Lab AI is for
Clinical laboratories
Check orders as they arrive, check claims before they’re submitted, and see why claims get denied.
Learn moreHospital laboratories
Verify claims against Medicare coverage rules and get paid faster.
Learn morePayers
Automate claim verification and prior authorization with scoring you can customize.
Learn more
Integrations
Connects to the data you already have
Lab AI works from your existing claims and order data.
Interfaces
Connect through our HTTP API, with support for formats such as HL7 through Mirth Connect.
- HTTP API
- HL7
- Mirth Connect
What Lab AI checks
Every order and claim is evaluated against the code sets and policies that drive lab reimbursement.
- CPT
- ICD-10
- LDS® relevance score
- Medicare LCD
- Medicare NCD
- Private payer policies
Mirth Connect is a trademark of its owner and is named only to identify a supported integration engine.
How to Buy
How to get Lab AI
Lab AI is set up for your lab’s own systems, so each lab gets its own quote. Getting started takes three steps.
1. See it with our team
Request a demoBook a demo and we’ll show you how Lab AI checks orders as they arrive and claims before billing, and the reports you’ll get.
2. Get your quote
Contact salesTell us where you want to use Lab AI: on incoming orders, on claims before billing, or both. We’ll send a quote for your lab.
3. Connect and go live
We connect Lab AI to your LIS or billing system, and it starts checking your orders and claims.
For your IT team: we connect through our API, or through HL7 using Mirth Connect.
Proof
The evidence behind Lab AI
The 2019 study ran the same kinds of checks Lab AI performs, LDS® scoring and Medicare LCD/NCD review, on two large sets of historical claims.
Leblow L, Hamill T, Beqaj S. Use of Laboratory Decision System as a Test Utilization Management Tool in Clinical Settings, Current and Future Perspectives. Journal of Clinical Laboratory Medicine. 2019;4(1).
Study type: Retrospective analysis of historical claims: 374,423 test claims (96,170 orders) from a reference laboratory and 294,870 claims from a PPO managing self-pay organizations, reviewed with the LDS® ranking system and Medicare LCD/NCD policies.
- Reference laboratory (374,423 test claims): 11.9% carried a “never covered” ICD-10 code, 12.8% did not meet Medicare policy, and 43.7% did not meet medical necessity under the LDS® ranking.
- Payer (294,870 claims): 10.2% carried an always-denied ICD-10 code and 10.7% would not have been supported by Medicare.
- In a 10,000-claim subset, LDS® identified a medically necessary alternative test or ICD-10 code for 96.4% of claims.
Beqaj S, Shrestha R, Hamill T. An Automated Clinical Laboratory Decision Support System for Test Utilization, Medical Necessity Verification, and Payment Processing. Interactive Journal of Medical Research. 2025;e46007. doi:10.2196/46007
Study type: Peer-reviewed viewpoint article describing LDS® and summarizing the reference-laboratory claims analysis. The authors note that more systematic testing is needed.
- Describes how LDS® scoring, testing indications and LCD/NCD policies support claim adjudication and payment processing.
- Concludes that more systematic testing is needed to evaluate effectiveness.
Disclosure: the studies above were authored or co-authored by Medical Database personnel, including our CEO, Dr. Safedin Sajo Beqaj. They are retrospective analyses of historical claims; figures about orders that “could have been corrected” are projections of what LDS® would have recommended, not results measured after deployment. Individual results will vary.
FAQs
Lab AI questions, answered
What does Lab AI check on each claim?
Lab AI verifies that the CPT and ICD-10 codes match the test or procedure, scores the test’s clinical relevance for the diagnosis, and cross-references Medicare LCD and NCD policies and private payer policies.
What powers Lab AI?
Lab AI applies our proprietary, knowledge-based scoring system, the same LDS® content that covers 2,300+ tests and 850+ diseases, together with payer policy rules. The content is continuously updated by medical experts.
Where in our workflow does Lab AI run?
In two places. At the front end, it runs real-time medical necessity checks on orders as they arrive, whether through an EMR-to-LIS interface or entered manually by your laboratory. At the back end, it checks billing claims and suggests corrections before they’re submitted, and its reports track claim statuses, denial codes and explanations afterward.
How does Lab AI connect to our systems?
Through our HTTP API, with support for formats such as HL7 through Mirth Connect.
Can payers use Lab AI?
Yes. Payers use Lab AI’s customizable scoring system to automate claim verification and prior authorization.
Will Lab AI eliminate our denials?
No tool can promise that. Lab AI helps you find and correct medical necessity problems before submission and shows where denials come from, but final coverage decisions are made by each payer.
Medical Database products provide decision support. They do not replace the professional judgment of the ordering provider, laboratory director, or treating clinician, and they do not guarantee coverage or payment, which are determined by each payer.
Request a demo
See where your claims are being denied
We’ll show you how Lab AI checks orders as they arrive and claims before submission, and reports denials by payer and test.
- We reply to schedule a time that suits you
- See how it fits your current workflow
- Ask our team about setup and pricing