Laboratory Medical Billing & Credentialing Services

At Oakview Medical Billing Solutions, we specialize in comprehensive billing and credentialing services tailored specifically for independent and hospital-based laboratories. Our expert team understands the unique challenges labs face, from complex payer policies to evolving regulations, and works diligently to help you achieve accurate reimbursement, compliance, and financial stability.

The Unique Challenges of Laboratory Billing

Laboratory billing requires precise coding, meticulous documentation, and proactive denial management to secure timely payments. Labs often struggle with:

• Frequent payer audits & policy changes: Laboratories are among the most audited healthcare entities, increasing the risk of denials and recoupments.

• Complex coding rules: Differentiating between CLIA-waived tests, molecular diagnostics, and advanced panels can lead to errors that delay payment.

• Bundled codes & fee schedules: Many tests are reimbursed under bundled rates, requiring clear documentation to avoid underpayments.

• Preauthorization & medical necessity: Labs must verify orders meet payer criteria to prevent claim denials.

• Insurance credentialing hurdles: Laboratories need to maintain active participation with multiple insurers to keep their referral base strong and revenue flowing.

Oakview’s Laboratory Billing Solutions

Our laboratory billing specialists provide end-to-end RCM services, including:

• Accurate coding & charge entry: Our certified coders ensure the right CPT, HCPCS, and ICD-10 codes are assigned for each test performed.

• Medical necessity verification: Automated workflows and team reviews ensure each test is justified and supported by documentation.

• Claim submission & tracking: We use advanced billing software to scrub, submit, and track every claim, reducing denials and speeding up reimbursements.

• Appeals & denial management: Our team proactively follows up on denied or underpaid claims, maximizing collections.

• Transparent reporting: You’ll receive regular performance reports detailing collections, denial trends, aging, and payer-specific issues.

• HIPAA-compliant services: We safeguard patient and client data with rigorous privacy and security measures.

Laboratory Credentialing Support

Credentialing is vital for labs seeking referrals from hospitals, group practices, and independent providers. Our credentialing experts handle every step:

Enrolling with Medicare & Medicaid
Contracting with commercial payers
Completing CLIA certification processes
Maintaining credentialing records & revalidations
Assisting with state-specific licensure and compliance updates

CPT Codes for Laboratory Services

Note: This table includes common lab tests but our billing services cover hundreds of CPT codes across specialized, molecular, and pathology testing.

Why Choose Oakview for Laboratory RCM?

Industry-leading denial resolution rates
Faster cash flow with reduced AR days
Increased collections through accurate coding
Dedicated account managers for personalized support
Customized solutions for independent and hospital-based labs

Let Oakview handle your laboratory billing and credentialing challenges so you can focus on delivering timely, accurate test results to your patients and provider partners.