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Laboratory Revenue Cycle Management (RCM) | Prolis LIS System
Prolis LIS — Revenue Cycle Management

Stop Leaving Lab Revenue on the Table

Prolis LIS delivers a fully integrated Laboratory Revenue Cycle Management solution from patient registration and order entry through claim submission, denial resolution, and final payment posting so your lab gets paid faster and in full.

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96%
First-Pass Clean Claim Rate
30%
Reduction in Days in AR
<24h
Average Claim Submission Time
40%
Fewer Denial Rework Hours
3×
Faster Reimbursement Compared to Manual Billing Workflows
What Is Lab RCM?

The Financial Engine Behind Every Successful Clinical Laboratory

Laboratory Revenue Cycle Management (RCM) is the end-to-end process that ensures your lab gets paid for every test it performs accurately, compliantly, and on time.

For clinical laboratories, the revenue cycle is uniquely complex. High test volumes, intricate payer rules, rapidly changing CPT and ICD-10 codes, prior authorization requirements, and aggressive payer audits create an environment where billing errors are costly and frequent. Studies show that laboratories lose an average of 5–15% of collectible revenue each year due to preventable billing inefficiencies, undercoding, and unworked denials.

Prolis LIS was built from the ground up with RCM woven into every workflow not bolted on as an afterthought. From the moment a test order is placed, the system is already working to ensure that order becomes a clean, paid claim.

Common Pain Points

Billing Challenges That Are Costing Your Lab Today

Without a tightly integrated LIS-RCM solution, labs face a cascade of financial and operational problems.

High Claim Denial Rates

Missing modifiers, mismatched diagnosis codes, and invalid patient data trigger automatic payer rejections each one requiring costly manual rework and delaying cash flow.

Manual Coding & Transcription Errors

Re-keying orders from the LIS into a separate billing system introduces human error at every step, leading to undercoding, overcoding, and compliance exposure.

Slow Reimbursement Cycles

Delayed submissions, incomplete documentation, and slow denial resolution stretch Days in AR well beyond acceptable benchmarks, straining lab cash flow.

Prior Authorization Bottlenecks

Specialty and genetic testing require upfront authorizations. Missing or expired authorizations are a leading cause of non-covered claim denials post-service.

Limited Billing Visibility

Without real-time dashboards, billing managers cannot identify denial trends, track payer performance, or take proactive action before revenue leaks compound.

Compliance & Audit Risk

Evolving CMS rules, LCD/NCD policies, and OIG audit targets require constant vigilance. Labs without built-in compliance controls face significant financial penalties.

Prolis RCM Capabilities

One Platform. Every Step of Your Revenue Cycle.

Purpose-built for the unique billing complexity of clinical laboratories, Prolis LIS connects clinical workflows directly to financial outcomes.

Real-Time Eligibility & Benefits Verification

Insurance verification failures are the #1 cause of preventable claim denials. Prolis LIS performs automated, real-time eligibility checks at the point of patient registration before any test is performed.

  • Instant eligibility queries across 1,800+ commercial and government payers
  • Patient liability estimation at check-in for point-of-service collection
  • Out-of-network benefit flags and deductible tracking
  • Secondary insurance coordination and coordination of benefits (COB) detection
  • Eligibility history log for audit defensibility

Intelligent Test Coding & Order-Level Claim Building

Prolis LIS maps every test order to the correct CPT, HCPCS, and ICD-10 codes automatically driven by a constantly updated payer specific rules engine. Your billing team spends time on exceptions, not on routine coding.

  • Automated CPT code assignment from test requisition data
  • ICD-10 diagnosis code suggestions based on ordering physician and test type
  • Payer-specific LCD/NCD coverage rules embedded at order entry
  • ABN (Advance Beneficiary Notice) generation for non-covered tests
  • Panel unbundling and bundling logic for maximum reimbursement compliance
  • Medical necessity validation before submission

Multi-Level Claims Scrubbing & Electronic Submission

Submitting an unclean claim costs your lab twice once in the denial, and again in the rework. Prolis applies a multi-layer scrubbing engine that catches formatting errors, coding conflicts, and payer-specific rule violations before any claim leaves the system.

  • ANSI X12 837P/837I validation for clean electronic claims
  • 500+ built-in payer-specific edit rules, continuously maintained
  • Duplicate claim detection and fragmented order consolidation
  • Direct clearinghouse integration for real-time acceptance/rejection status
  • CMS-1500 and UB-04 form generation for paper exception workflows
  • Claim status tracking through the entire payer adjudication lifecycle
Denial Management

Turn Denials Into Recovered Revenue Automatically

The average laboratory denial rate runs between 5% and 10% of claims. Left unworked, denied claims become write-offs. Prolis LIS transforms denial management from a reactive, labor-intensive process into a proactive, automated revenue recovery engine.

  • Root-Cause Denial Analytics — Identify denial patterns by payer, CPT code, provider, and facility to eliminate systemic issues at the source.
  • Automated Appeal Workflows — Trigger rule-based appeal letter generation with supporting documentation in one click.
  • Priority Work Queue Routing — Route high-value or time-sensitive denials to senior billing staff before timely filing deadlines expire.
  • ERA / EOB Auto-Posting — Electronic Remittance Advices post automatically, with exceptions highlighted for human review only.
  • Secondary & Tertiary Payer Crossover — Automatically cross-file balances to secondary insurance or patient responsibility after primary adjudication.
78%
of Worked Denials Successfully Overturned
14d
Average Denial Resolution Time
<5%
Write-Off Rate for Labs Using Prolis RCM
$0
Timely Filing Losses With Auto-Prioritization
How It Works

From Order Entry to Payment Posted in One Unified System

Prolis eliminates the gap between clinical operations and billing every step is connected, automated, and auditable.

Patient Access & Registration

Patient demographics, insurance, and ordering provider data are captured once accurately — and flow through every downstream process without re-entry.

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2

Real-Time Eligibility Verification

Before the specimen is collected, Prolis verifies active coverage, benefits, and prior authorization requirements across all payers.

Order & Specimen Management

Test orders auto-assign CPT and diagnosis codes, check LCD/NCD coverage rules, and generate ABNs where required before the specimen reaches the analyzer.

3
4

Results Release & Claim Generation

When results are verified and released, a completed claim is automatically constructed and queued no manual billing entry required.

Scrubbing, Submission & Tracking

Claims pass through the multi-layer scrubbing engine and are submitted electronically to payers via integrated clearinghouse with real-time status tracking.

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6

Payment Posting & Reconciliation

ERAs auto-post with intelligent exception routing. Patient balances are calculated and statements generated automatically.

Denial Work & Reporting

Any denied claims enter a prioritized work queue with root-cause analysis, appeal templates, and resubmission tools all within the same platform.

7
Revenue Intelligence

See Every Dollar Before It Becomes a Problem

Prolis RCM Analytics gives lab directors and billing managers a real-time financial command center not a report you pull once a month when the damage is already done.

Customizable dashboards surface your most critical KPIs: Days in AR by payer, denial rate by test category, net collection ratio, clean claim rate, and aging bucket distribution all updated in real time and accessible from any device.

  • Configurable executive, manager, and coder-level dashboard views
  • Payer performance benchmarking against industry standards
  • Undercoding and missed charge detection alerts
  • Monthly trending and year-over-year revenue comparisons
  • Scheduled report delivery to key stakeholders
28d
Days in AR
↓ 12d vs. Last Qtr
96.4%
Clean Claim Rate
↑ 4.2% vs. Last Qtr
4.8%
Denial Rate
↓ 2.1% vs. Last Qtr
97.2%
Net Collection Ratio
↑ 3.5% vs. Last Qtr
$1.4M
Pending AR (0–30 Days)
↑ 8% Volume Growth
78%
Appeal Success Rate
↑ 11% vs. Last Qtr
Compliance & Security

Built-In Compliance That Protects Your Lab Every Day

Regulatory compliance isn't a feature you add on it's foundational to how Prolis LIS is designed, developed, and maintained.

HIPAA

Full PHI encryption, audit trails, and role-based access control protecting patient data at every touchpoint

CLIA

Laboratory workflow controls aligned with CLIA standards for clinical testing quality and personnel requirements

CMS / LCD

Continuously updated Local and National Coverage Determination (LCD/NCD) rules embedded directly in the ordering workflow

OIG

Built-in fraud and abuse safeguards aligned with OIG compliance program guidance for clinical laboratories

Prolis Compliance Update Engine: Our dedicated compliance team monitors CMS rulemaking, payer policy bulletins, CPT/ICD-10 annual updates, and OIG work plan releases and pushes updates to your system automatically. Your lab stays current without lifting a finger.

Specialty Billing Support

Purpose-Built Billing Rules for Every Lab Specialty

Not all lab billing is created equal. Prolis includes specialty-specific billing modules with pre-configured rules for each discipline's unique coding and compliance requirements.

  • Toxicology & Drug Testing
  • Anatomic Pathology
  • Microbiology
  • Clinical Chemistry
  • Hospital Reference Lab

Molecular & Genetic Testing Billing

Molecular and genomic testing carries some of the most complex billing requirements in all of healthcare. Prolis LIS manages the full lifecycle from prior authorization and MAAA (Multianalyte Assays with Algorithmic Analyses) coding to Tier 1/Tier 2 stacking rules and proprietary lab code (PLA) billing. Our system includes built-in payer coverage decision logic for major commercial plans and Medicare MACs, so your team is never coding blind.

Tier 1 & Tier 2 MoPath CodesMAAA / Algorithmic TestsPLA CodesPrior Auth TrackingStacking Rules EngineBRCA / Hereditary Panel BillingPharmacogenomics CodingABN Generation
Proven Results

The Financial Impact Labs Experience With Prolis RCM

These outcomes reflect performance benchmarks from labs that have transitioned from siloed billing systems to Prolis LIS integrated RCM workflows.

+18%
Average Increase in Net Revenue Collection in the First Year
-30%
Reduction in Average Days in Accounts Receivable
-60%
Fewer Manual Billing Staff Hours Per 1,000 Claims Processed
78%
Denial Overturn Rate Through Systematic Appeal Management
2×
Faster Patient Balance Collection via Digital Billing Statements
<1%
Timely Filing Write-Off Rate With Automated Submission Queuing
Seamless Integrations

Prolis RCM Connects to Your Entire Ecosystem

A disconnected billing system is a revenue-leaking system. Prolis LIS integrates bidirectionally with the platforms, payers, and partners your lab already uses.

Clearinghouse & Payer Connectivity

Direct integration with leading clearinghouses for electronic claim submission, real-time status, and ERA retrieval across 1,800+ payers Medicare, Medicaid, and all major commercial plans.

EHR & EMR Systems

Bidirectional HL7 v2 and FHIR R4 interfaces with Epic, Cerner, Athenahealth, DrChrono, and 50+ other platforms ensure ordering physician data flows cleanly into every claim.

Practice Management Systems

Sync patient demographics, encounter data, and payment transactions with leading PM systems to eliminate double-entry and maintain a single source of financial truth.

Analyzer & Instrument Interfaces

Verified results auto-trigger claim generation, removing the manual step between result release and billing. Supports ASTM and HL7 interfaces for all major analyzer brands.

Patient Payment Portals

Integrated patient billing portal with online payment, payment plan setup, and digital statement delivery reducing collection costs and improving patient satisfaction.

Business Intelligence & Reporting

Native connectors to Power BI, Tableau, and custom data warehouse environments for enterprise-level financial analytics and cross facility performance benchmarking.

Frequently Asked Questions

Questions Lab Directors Ask About RCM

How is Prolis RCM different from a standalone medical billing software?

Standalone billing software receives data from your LIS creating a gap where errors, omissions, and delays occur. Prolis RCM is embedded inside the LIS itself, so claims are built automatically from verified test data with no manual data transfer, re-keying, or interface failure risk.

Can Prolis work with our existing billing company or outsourced RCM vendor?

Yes. Prolis supports hybrid billing models. Your in-house team and external billing vendor can both access the same platform with role-based permissions improving oversight, reducing errors, and maintaining a single source of billing truth.

How quickly do labs typically see ROI after implementing Prolis RCM?

Most labs see measurable improvement in Days in AR and clean claim rate within the first 60–90 days post go-live. Net revenue improvement typically reaches its peak within the first 6–12 months as denial root causes are systematically eliminated.

Does Prolis handle both Medicare and commercial payer billing?

Yes. Prolis supports full Medicare (Part B, MAC-specific LCD rules), Medicaid (state-by-state), and all major commercial payers. Payer-specific rules are maintained automatically by our compliance team and pushed to your system with no manual intervention required.

How does Prolis handle prior authorization for high-cost tests?

Prolis includes a prior authorization management module that flags tests requiring auth at order entry, tracks authorization status and expiration dates, and prevents result release on non-authorized tests eliminating post-service auth denials.

Is Prolis LIS suitable for both small independent labs and large reference labs?

Prolis is designed to scale. Independent labs with a single billing seat benefit from automation that replaces manual work. Large reference labs with multi-facility operations and high claim volumes benefit from the enterprise-level analytics, user access controls, and workflow routing capabilities.

Ready to Optimize Your Lab's Revenue Cycle?

Stop Losing Revenue You've Already Earned

Join clinical laboratories across the country that use Prolis LIS to collect more, faster with less manual effort and greater compliance confidence. Schedule a personalized RCM assessment and live platform demo with our laboratory billing specialists today.