Transforming Prior Authorization: How a National Laboratory Achieved Measurable Gains with careviso and XiFin

The Challenge: Cutting Through the Complexity of Prior Authorization

Rising administrative burdens are causing delays in testing, slowing patient access to critical diagnostics and care, and straining healthcare operations nationwide. Healthcare provider organizations face mounting challenges in meeting payer policies and documentation requirements, particularly around prior authorization (PA) processes.

Common prior authorization challenges include:

• Fragmented, unstructured payer policy data: Policies are scattered across PDFs, portals, and payer websites, making them difficult to search, compare, or standardize.
• Complex PA criteria that vary by payer: Complex testing often requires specific documentation, medical history, and clinical notes.
• High manual effort and turnaround time: Billing teams spend hours interpreting medical necessity criteria and payer policies, delaying testing and therapy.
• Siloed knowledge: PA expertise resides with individuals, making it difficult to share or transfer during onboarding.
• Inconsistent documentation requirements: Lack of standardization across payers impacts PA approvals and appeal success.
• Errors maintained through the appeals process: Missing documentation or justification recurs without a systematic solution.

The Solution: A Proven Partnership Between careviso and XiFin

One large national laboratory specializing in complex diagnostic testing faced these challenges head-on. Before partnering with careviso and XiFin, the lab experienced lengthy turnaround times, high administrative workloads, inconsistent approval rates, and limited visibility into payer requirements.

Recognizing the need for a more integrated and scalable approach, the laboratory selected careviso as its prior authorization partner and XiFin as its revenue cycle management provider. With a proven track record of working together, the two companies delivered a streamlined, highly automated workflow supporting new operational efficiencies, payer policy compliance, and real-time transparency.

About careviso seeQer

careviso's seeQer platform simplifies and automates the prior authorization process, combining intelligent technology with deep payer rule integration. By replacing manual workflows with automated, data-driven processes, seeQer enables diagnostic providers to operate more efficiently and focus on delivering high-quality patient care.

About XiFin Empower RCM

Empower RCM streamlines and modernizes the revenue cycle management process by combining intelligent automation, unified workflows, and flexible integrations to reduce administrative burden and accelerate reimbursement. By eliminating fragmented manual tasks and providing data-driven visibility into financial performance, Empower RCM helps healthcare organizations improve efficiency, minimize denials, and maintain a healthier bottom line.

The Results: Measurable Improvement Across Key Metrics

To ensure an accurate and meaningful comparison, the analysis focused on a comprehensive dataset spanning nearly two years of prior authorization activity for the laboratory's highest-volume test.

• Timeframe: January 1, 2024 – December 2025
• 783 payers included
• Total order volume: 110,658 accessions

After implementing careviso seeQer and XiFin Empower RCM, the laboratory achieved significant gains:

• Average time to submit prior authorizations decreased 48%, from 3.1 days to 1.6 days
• Average time to close prior authorizations decreased 53%, from 8.1 days to 3.8 days
• 456 payers (58%) experienced increased approval rates, resulting in:
  • A 13.5% increase in paid claims
  • An average increase of $347.33 in payment per procedure

Beyond Prior Authorization: Revenue Integrity and Administrative Relief

The benefits of transitioning to careviso and XiFin extended beyond the PA process itself. By reducing submission errors and improving approval rates, the laboratory experienced fewer downstream claim denials and a notable decrease in administrative burdens. Billing teams were able to focus on higher-value functions rather than manual follow-up or correction cycles, improving revenue and accelerating reimbursement.

With key portions of the PA workflow streamlined and real-time visibility into payer requirements and authorization statuses, the laboratory reduced the manual processes typically needed to reconcile missing or delayed authorizations.

A New Standard for Prior Authorization

The results of this case study highlight how partnering with careviso and XiFin delivers measurable, lasting impact across the entire prior authorization workflow. Diagnostic providers and healthcare organizations can expect:

• Higher approval rates driven by precise clinical and administrative validation
• Faster submission and approval times that keep patient care moving without unnecessary holdups
• Reduced administrative workload through automation and real-time data intelligence
• Increased focus on quality and continuous improvement as teams redirect time toward higher-value tasks
• Expanded provider engagement and enrollments supported by clear, consistent requirements and simplified processes

Together, this transformation reshapes how laboratories and diagnostic providers manage prior authorization, improving efficiency, increasing transparency, and supporting a more patient-centered approach to care delivery.

‍

About careviso

careviso created seeQer, a complete technology platform that increases patient access to care by delivering cost estimates, administrative requirements, and approvals in real time. careviso's mission is to support patients, providers, and payers with total access to healthcare by automating the most complex problems in the industry: prior authorizations and financial transparency.

About XiFin

XiFin is a healthcare information technology company that empowers organizations to navigate an evolving and complex healthcare landscape. The XiFin Empower platform delivers AI-enabled operational efficiency, workflow automation, and comprehensive solutions spanning revenue cycle management, clinical workflow enablement, and patient engagement.

‍