How Labs Can Navigate the Prior Auth Surge
The days of simple lab orders are long over. Increasingly, payors are demanding prior authorizations for tests that were once routinely reimbursed—especially in toxicology, genetic testing, and high-cost diagnostics. What used to be a quick turnaround is now often a waiting game tangled in red tape. For many labs, this trend isn’t just frustrating—it’s threatening their revenue and slowing patient care.
Why It’s Happening
Several forces are driving the increase in prior authorizations:
Cost containment: Insurers are scrutinizing expensive lab services to minimize unnecessary testing.
Abuse and overuse concerns: In areas like toxicology and pharmacogenomics, payors are wary of overutilization and are using authorizations to control volume.
Shifting medical policies: Payor rules change frequently, and more tests are being moved under the “requires prior auth” umbrella each quarter.
This isn’t just a temporary headache—it’s becoming the new normal.
The Impact on Labs
Prior authorizations create a massive operational burden:
Delays in testing and billing
Higher denial rates
Increased manual work for lab staff
Frustrated referring providers and patients
For labs that aren’t equipped to keep up, the result is clear: lost revenue, compliance risk, and strained client relationships.
What Labs Can Do
To survive and thrive in this environment, labs must:
Stay on top of payor policy updates
Verify medical necessity at the point of order
Proactively gather and submit documentation
Automate as much of the process as possible
But doing this manually or with legacy systems just isn’t sustainable anymore.
How Cellarian Helps
At Cellarian, we’ve built automation tools designed specifically for labs navigating the complexity of prior authorizations and medical necessity documentation requirements. Our platform ensures that orders are supported with the right clinical data—before the claim goes out—helping labs stay compliant, reduce denials, and recover revenue they’re currently missing.
Let Cellarian streamline the process so your staff can stop chasing paperwork and get back to what matters: delivering high-quality lab services and growing your business.
