Payment / Payer Data + Test Workflow Dashboard.
From Pre-Auth Chaos to Predictable Cashflow: How NonStop Streamlined the Genomics Billing Journey
NonStop helped a leading diagnostics company integrate payer data, lab workflows, and financial analytics, eliminating pre-auth bottlenecks, reducing denials, and accelerating reimbursements without disrupting operations.
The Challenge
In the world of genetic testing, time isn't the only precious thing, so is cashflow.For many genomics labs, payer pre-authorization and claim denials have become silent revenue killers.
Each assay had its own rules, documentation templates lived in shared folders, and eligibility checks happened in silos.Finance and operations teams had little real-time visibility into pre-auth status or payer-wise performance. The result? Delayed tests, denied claims, and frustrated patients waiting for care.
The organization needed a more innovative way to:
- Integrate payer rules and coverage logic into daily lab workflows.
- Surface pre-auth status at every step of the test lifecycle.
- Give finance and ops teams real-time visibility across assays, payers, and claims.
The Approach
From Reactive Billing to Intelligent Payment Workflows
NonStop partnered with the client's finance, RCM, and lab operations teams to build an AI-enabled Payment & Payer Workflow Dashboard. This unified system connects payer data, lab test workflows, and revenue metrics in real time.
Our goal: simplify payer interactions, minimize manual tasks, and make every test financially predictable.
Payer Rules Engine
We designed a configurable rules engine that codifies payer-specific coverage criteria organized by plan, state, and assay.
This ensures every order automatically validates eligibility before a test even starts, preventing avoidable denials downstream.
Eligibility & Pre-Auth Connector
Built secure integrations with clearinghouses and payer APIs to automate eligibility checks, documentation submission, and real-time pre-auth status tracking.
Workflow Tracker
Linked payer data directly with lab systems, mapping kit status, lab steps, and document readiness across the test journey.
This gave counselors, billing teams, and lab managers one synchronized view.
Denial Analytics Engine
Developed a smart analytics layer that captures root causes of denials, classifies them into taxonomies, and generates predictive denial scores to prevent recurring issues.
Finance & Operations Dashboard
Created a real-time dashboard that visualizes:
- Denial rates by payer and assay
- Cost-to-collect
- DSO (Days Sales Outstanding)
- Clean claim yield
- Overall reimbursement trends
This enabled financial transparency and proactive intervention before issues escalated.
Data Inputs
The system unifies clinical, financial, and payer data into one integrated framework:
- Orders: CPT and LOINC codes, mapped to tests and payers.
- Payer Eligibility: Verification of plan coverage and benefits.
- Prior-Auth Submissions: Forms, documentation, and approvals.
- Claim Outcomes: EDI 837/835 data for payments and denials.
- Test Costs: Cost-per-assay and collection metrics for margin tracking.
Security, Compliance & Reliability by Design
With sensitive patient and financial data at stake, NonStop engineered robust, compliant data exchange across systems
Minimum Necessary PHI: Shared only essential data with payers.
Role-Based Access: Controlled visibility for counselors, billing, and finance teams.
Audit Trails: Complete traceability of all pre-auth and claim submissions.
Encryption in Transit: Secure communication between payer systems and lab infrastructure.
The Impact
Measurable Results, Meaningful Change
Prior authorizations stopped slowing everything down and became a predictable part of the workflow
Claim denials dropped, reducing rework and financial leakage
Clean claims became consistent, not dependent on manual corrections
Cash flow improved as reimbursement cycles became shorter and more reliable
Administrative cost pressure eased as collection became more efficient
Why It Matters
This project reimagined how financial workflows in genomics can align with clinical operations
without adding more systems or manual steps.
By combining:
AI-assisted payer rules
Real-time workflow tracking, and
Outcome-driven analytics
NonStop helped the organization shift from reactive billing to proactive cashflow management,
unlocking both revenue and time for patient-focused work.
