Complete the order and close the follow-up.
Track orders held for missing requisitions, clinical records, or provider information. Assign follow-up, collect missing items, and confirm the handoff to the receiving team.
Enterprise AI for payer operations
Manage lab benefits before testing begins.
Bring missing orders, clinical documentation, benefit requirements, and prior authorization into one coordinated workflow. Gistia builds and supports software and AI that connect providers, laboratories, and payer teams around your approved policies.
Trusted by & Technology Partners
AccuMed Laboratories
Connected payer workflows
Close the gaps between the order, the benefit, and the claim.
Start with the recurring work that holds cases up. Connect the steps as your operating needs grow.
Put approved benefit requirements into the workflow.
Connect the requested test with the applicable plan, formulary, coverage and medical-necessity criteria, network requirements, and documentation needs before testing begins.
Keep authorization preparation and status visible.
Identify requirements under approved rules, assemble supporting evidence, route the submission, and track the payer response. Keep order completeness and authorization status distinct.
Give reviewers the evidence behind each case.
Bring clinical context, source records, criteria versions, and open questions into one review record. Route exceptions to authorized reviewers and record their decisions.
Make the next request specific and actionable.
Show ordering teams what is missing, why it is required, and who needs to respond. Use recurring gaps to focus provider guidance and track unresolved requests.
Connect downstream issues to the original order.
Link order and authorization records with available claim responses. Trace recurring problems, assemble appeal evidence, and keep the next action assigned.
From order to follow-through
Keep ownership clear at every handoff.
Providers, laboratories, and payer teams share the case context while retaining their own responsibilities.
Resolve missing orders and records.
Identify the missing items, request corrections, and confirm the receiving team has the agreed information.
Check the applicable benefit requirements.
Organize approved criteria, documentation needs, network rules, and any required authorization steps.
Make the case ready for payer review.
Present evidence and exceptions to the authorized reviewer, with the policy version and unresolved questions visible.
Return the status and track the next action.
Connect the recorded decision with provider and lab follow-up, testing status, and available claim information.
Operating visibility and medical economics
Measure what changes across the whole path.
Agree the baseline, accountable owners, and success measures for the first scope before expanding.
See what is still missing.
Track unresolved requests, queue age, follow-up closure, and time to the confirmed handoff.
Understand where teams spend time.
Measure case-readiness time, manual touches, exception volume, and review turnaround.
Trace downstream patterns to their source.
Measure testing utilization and case costs against the agreed baseline, alongside order-to-claim gaps, denials, and appeals.
Custom AI Solutions
Connect the lab benefit operation across teams.
Bring benefit policy, provider and lab coordination, authorized review, and medical economics into a connected operating path.
Best when
Explore Custom AI for Payers →Solution CatalogThe priority crosses benefit policy, ordering, laboratory relationships, review, claims, or several systems.
Start with a recurring order or review problem.
Evaluate Order Completion, Prior Authorization, or the Payer Review Portal around your approved requirements and existing systems.
Best when
Explore Payer Solutions →The immediate need has a clear owner, workflow, and measurable outcome.
Related healthcare work
See related work across healthcare operations.
Examples in laboratory claims, rule coordination, and patient financial support.
Claims operations
Reducing claim denials through better processing and intelligence.
Claims processing and denial insight were connected to reduce rework and improve payment flow.Read the case study →
Network rule operations
Connecting network rules and contract coordination.
A pathology network connected rule management, assignments, and contract execution.Read the case study →
Financial-assistance operations
Financial assistance moved from paper intake to a connected path.
Applications, document data, and billing were connected to support faster access decisions.Read the case study →Where does your lab benefit workflow break down?
Start with one test category, laboratory relationship, or order population. We can help define the missing-order workload, benefit requirements, review responsibilities, system connections, and measures for the first scope.