Assembling complete payer-review packets before testing for a diagnostic laboratory.

One of our clients, a diagnostic laboratory network, receives complex test orders from providers and health systems. Before testing, the operation may need to confirm patient and plan context, order completeness, coverage conditions, diagnosis and clinical documentation, prior authorization state, laboratory criteria, and the evidence required for payer review.

Before Carric, staff moved between the lab order, provider documentation, payer rules, authorization portals, policy references, and internal work queues. Deterministic checks such as required fields and current plan context were mixed with evidence interpretation and decisions that required qualified human authority. Missing documentation often appeared late, after several manual touches.

One order revealed the recurring failure mode. The required clinical evidence existed across a note, a result, and a specialist record, but the packet did not show how those records connected to the applicable payer criteria. Testing readiness depended on rebuilding the chain and identifying the one unresolved condition before work proceeded.

Carric built a governed pretesting payer-review system. It assembles the order and coverage context, runs deterministic completeness checks, retrieves and organizes relevant evidence, maps records to the applicable criteria, and routes unresolved clinical or payer conditions to the appropriate reviewer. Carric does not make a clinical determination or guarantee coverage. The case records the human decision and every source used before the laboratory proceeds.