Client: Infinite Genomics, LLC
Infinite Genomics was formed as a molecular diagnostic laboratory in 2021. Although the lab is located in North Little Rock Arkansas, it intended to offer PCR services to providers across the nation. To put that plan into action, the owners reached out to Lighthouse to inquire about our Payer Strategy Solutions.
“Their contract position was standard as they did not have many payer contracts prior to engaging us,” notes Brennan Burns, VP of Payer Contracting for Lighthouse Lab Services, who heads the payer strategy team alongside VP of Managed Care Strategy Brian Burns. “Since we specialize in working with lab startups, we knew there would be a handful of contracts we could obtain right away.”
Client Challenges and Objectives
Getting a lab credentialed with insurance providers is essential to a smooth and consistent flow of reimbursements. Labs that remain out-of-network with particular payers often struggle to receive payments from those networks and will likely see payers try to steer patients in their region to in-network providers.
In this case, the lab’s objective was to begin by obtaining national Medicaid and Blue Cross Blue Shield contracts, hoping to secure a partner to advance credentialing expeditiously.
- RELATED ARTICLE: 6 Tips for How to Get In-Network with Insurance Companies
Lighthouse’s Payer Strategy Solutions Team provides a full suite of managed care advisory and consulting services to their clients. By collaborating with managed care companies, health systems, and providers, they offer subject matter expertise and insights into strategic planning, managed care contracting, revenue cycle, and value-based care contracting.
Their past experience working on the payer side and understanding the contracting process from the payer perspective is a unique competitive advantage. They have also maintained many contacts and connections on the payer side, which they utilize to expedite certain contracts or overturn disputed denials.
Within the first year of working with Lighthouse, 13 new contracts were secured for the lab. To date, Infinite Genomics has 18 contracts in place through Lighthouse Payer Strategy Solutions. Those contracts are a combination of Medicaid, MCOs, and Blue Cross Blue Shield (BCBS). The lab has been successful in offering services nationally and now have strong sales territory managers in place.
“These BCBS networks are typically closed to many labs, but with our experience and relationships, they trust the labs we bring them are quality and worth bringing in-network,” Brennan Burns says, noting one key advantage of working with Lighthouse for contracting.
“The Payer Strategy Solutions team at Lighthouse engaged quickly and with expertise to secure Medicaid contracts. The environment for lab credentialing is a tough one and we rely on their knowledge to guide us in actions to appeal or reapply when denials are received. Brennan Burns has worked hard to keep us on track and has often been available to brainstorm over tactics. I’m happy about the relationship being developed as we advance on our growth track across the nation!”
–Hil Dupwe, President, Infinite Genomics
If you’re looking for a partner to assist with payer contracting, credentialing, or examining your overall RCM health, don’t hesitate to contact us today for a free consultation.