90% Faster Packet Submissions | Prior Authorization Automation
See how Agentic AI bridged the gap between Laboratory Information Management System (LIMS) and Payer Portals.
Project Scope
In late 2024, we partnered with a high–volume Genetic Diagnostic Lab in the Midwest. They specialize in hereditary cancer screening and prenatal testing – a sector where reimbursement rules are notoriously complex and Prior Authorizations (PA) are mandatory for almost every sample.
While the lab utilized a leading third–party diagnostic management portal to handle the complexity of genetic PAs and patient cost estimates, the process itself was still manually driven.
Their Accessioning Team was drowning, spending 40% of their day manually transferring data from their Lab Information Management System (LIMS) into the external portal.
The goal was simple:
To eliminate the "double–entry" tax and make most of the PA packet submission lifecycle – all without replacing their existing tech stack.
(This case has been anonymized for confidentiality.)
Main Challenge | The "Double-entry" Bottleneck
In genetic testing, a sample cannot enter the "Wet Lab" (processing) until the administrative work is clear.
This client’s LIMS (where the order lives) and the Third–Party PA Portal didn’t speak to each other.
For every single test (CPT 81408, 81211, etc.), a staff member had to open the LIMS, copy the Patient Demographics, Insurance Info, and CPT codes, switch tabs, and paste them into the PA portal.
This took 8–12 minutes per case.
With volumes exceeding 500 accessions per week, the lab was losing ~80 hours of labor weekly just to data entry. These figures capture only hands-on data entry time and exclude the often longer delay while samples waited in queue for staff availability.
Samples were sitting in the refrigerator waiting for administrative clearance. Turnaround Time (TAT), the lab’s most competitive metric, was suffering not because of science, but because of data entry speed.
In short:
This client needed an automation that was both:
- a "Digital Bridge" – which moves data from LIMS to the Prior Authorization portal instantly 24/7,
- a “Digital workforce” – that takes the strain off the RCM team members' backs.
Solution | Prior Authorization Automation
We didn't need to rebuild their infrastructure. We just fully automated it.
We started with deploying an agentic AI workflow orchestration to act as the middleware between the LIMS and the external PA portal. This was the aforementioned “digital bridge".
The solution operates on a strictly event–driven architecture designed to eliminate the latency between sample receipt and administrative clearance.
We also made this PA automation bi–directional.
Once the submission is logged, the agent waits to capture the "Patient Cost Estimate" generated by the portal, scrapes this specific dollar amount, and writes it directly back into the LIMS.
This ensures that the billing team has immediate, real–time visibility into out–of–pocket expectations without ever needing to leave their primary system or log into a third–party site.
Instead of manual batches, the agent continuously monitors the LIMS database and triggers the automation sequence the moment a sample is accessed and marked as “Received.”
On top of that it immediately extracts the necessary Patient PHI, NPI validation, ICD–10 diagnosis codes, and the required Genetic CPT panels.
The agentic AI automation then uses a secure browser to interface directly with the external PA portal, via the "New Case" wizard to input data and select test menus with absolute fidelity to the original requisition.
It is worth noting that genetic testing often requires attaching clinical notes (Family History). The Agent was configured to locate the PDF requisition in the LIMS, verify it matches the patient, and upload it directly to the PA portal's documentation tab.
How the Prior Authorization Automation Works?
- Listens: Detects new order in LIMS.
- Validates: Checks against NPI Registry
- Submits: Logs into the PA portal, auto–fills 100% of fields, and uploads clinical PDFs.
- Updates: Scrapes the PA Status (Approved/Pending) and Cost Estimate.
- Syncs: Writes the Auth Number and Estimate back into the LIMS.
- Alerts: If the portal flags "Prior Auth Not Required" or "Info Missing," the agent tags the case in the LIMS for human review.
Results
The impact was immediate.
By removing the manual entry barrier, the "Time to Wet Lab" (the time from sample receipt to testing start) dropped drastically.
The backlog of samples waiting for admin clearance dropped to zero. Transcription errors (typos in Member IDs) were eliminated, reducing downstream denials.
The automated sync of "Cost Estimates" allowed the lab to collect copays upfront more effectively, improving collections by 15%.
In short:
Our event-driven agent significantly improved RCM team capacity.
Summary
What was once a manual chokepoint is now a silent, invisible utility.
By deploying Prior Authorization Automation, this diagnostic lab didn't just save money on data entry; they improved their competitive advantage by delivering results to patients faster.
This project proves that you don't need to replace your portals to fix your workflow–you just need an Agent to manage them.
Ready to scale your lab without growing headcount?
Let’s talk. In just 15 minutes, we’ll cut through the noise and see if automation works for you.
