RequiSure Operating Model
How RequiSure coordinates intelligence and readiness across the provider EMR, laboratory, and revenue cycle — without replacing any of them.
RequiSure is not the EMR/EHR, LIS, billing/RCM platform, clearinghouse, or payer system. It is a reimbursement-readiness intelligence and workflow-control layer connecting them.
Current / First-Pilot EnvironmentConfirmed identities
Provider / Order Source (To Be Confirmed) → RequiSure → CrelioHealth (current & first-pilot LIS) → PayMedics / RCM → Payer Outcome. Every external platform remains NOT CONNECTED.
Provider / Order SourceOrder originTO BE CONFIRMEDNOT CONNECTED
RequiSureReadiness IntelligenceTHIS PRODUCTIMPLEMENTED
CrelioHealthCurrent / first-pilot LISCONFIRMEDNOT CONNECTED
PayMedics / RCMReceives billing from CrelioHealthCONFIRMED · method TBCNOT CONNECTED
Payer OutcomeNovitas JH · BCBSCONFIRMED context · rules TBCSIMULATED / FUTURE INTEGRATION
Future / Target EnvironmentConceptual · not committed
Potential Provider / AdvanceMD → RequiSure → INVOPAD or another LIS → PayMedics / RCM → Payer Outcome → RequiSure. Illustrative only — no APIs, no commitments; every platform remains NOT CONNECTED.
Potential Provider / AdvanceMDConceptual — not committedPOTENTIAL / FUTURENOT CONNECTED
RequiSureReadiness IntelligenceTHIS PRODUCTIMPLEMENTED
INVOPAD or another LISFuture / targetPLANNED · not committedNOT CONNECTED
PayMedics / RCMBilling / Revenue CycleCONFIRMED · method TBCNOT CONNECTED
Payer OutcomeNovitas JH · BCBScontext · rules TBCNOT CONNECTED
RequiSureOutcome IntelligenceTHIS PRODUCTIMPLEMENTED
Provider / Order Source
System: To Be Confirmed (AdvanceMD not currently in use — potential future)
Owns
- Demographics
- Insurance
- Encounter
- Diagnoses
- Clinical notes
- Medications
- Allergies
- Provider intent
- Signed order
- Provider workflow
- Returned results
Must not own
- RequiSure proprietary payer/readiness logic
RequiSure
System: RequiSure (this product)
Owns
- Clinical evidence extraction
- Evidence verification
- Coverage-readiness logic
- Policy/rule evaluation
- Missing-evidence identification
- Readiness determination
- Clarification workflow
- Prior-auth / ABN status workflow
- Hold / release workflow
- Evidence Packet
- Prebilling recheck
- Audit
- Analytics
- Outcome intelligence
Must not own
- Specimen processing
- Laboratory testing
- Result validation
- Claim submission
- Payment posting
CrelioHealth / LIS
System: CrelioHealth — current & first-pilot LIS (interface TBC; INVOPAD future/planned)
Owns
- Accessioning
- Specimen tracking
- Test routing
- Assay workflow
- Quality control
- Result verification
- Result transmission
- Transmits billing data to PayMedics
PayMedics / RCM
System: PayMedics — receives billing from CrelioHealth; technical method TBC
Owns
- Charge review
- Claim creation
- Claim edits
- Clearinghouse submission
- Denial work
- Appeals
- ERA/EOB posting
- Patient billing
- Collections