Questions We Need Answered Before Live Pilot
Turn tomorrow's session into structured requirements. Capture answers and mark their state.
Nothing here is assumed. Each item stays “Unanswered” until a person provides a validated answer.
Systems (Confirmed)
Which LIS is used (current & first pilot)?Confirmed
Answer: CrelioHealth — current & first-pilot LIS confirmed; INVOPAD is future/planned; exact API/interface TBC — Collaborator confirmation
Where does PayMedics receive billing information from?Confirmed
Answer: PayMedics receives billing information from CrelioHealth (technical method & electronic return TBC) — Collaborator confirmation
Is AdvanceMD currently in use?Confirmed
Answer: Not currently in use — potential/future provider system only — Collaborator confirmation
What is the current provider / order source?Unanswered
Scope (Confirmed)
Initial test category?Confirmed
Answer: Respiratory Pathogen Panel (RPP) — Collaborator confirmation
Which panel will the first pilot use?Confirmed
Answer: Keenan's current RPP panel (intended) — Collaborator confirmation
Medicare geography / MAC?Confirmed
Answer: Texas · Novitas Jurisdiction H — Collaborator confirmation
Commercial payer category?Confirmed
Answer: BCBS — confirmed at high level; exact entity/plan/product To Be Confirmed — Collaborator confirmation
Panel / Policy
What exact RPP panel?Unanswered
What exact CPT/HCPCS?Unanswered
What exact Novitas LCD/article?Unanswered
What exact medical-necessity rules apply?Unanswered
Current Workflow
How does an order currently enter CrelioHealth?Unanswered
Who reviews an order before testing?Unanswered
Who resolves missing information?Unanswered
At what point does the lab incur unrecoverable testing cost?Unanswered
Integration
How does CrelioHealth transmit billing data to PayMedics?Unanswered
Can PayMedics return denial/payment data electronically?Unanswered
What CrelioHealth API/interface capability exists?Unanswered
Operations
Who handles prior authorization?Unanswered
Who handles ABNs?Unanswered
Who handles escalations?Unanswered
Validation
What is the actual denial rate?Unanswered
Which categories constitute the estimated 50%?Unanswered
What percentage is truly preventable pre-service?Unanswered
What historical denial data can be used for validation?Unanswered