The engine
A charge is a claim about a diagnostic event
Every billing problem in diagnostics is a data problem wearing a finance costume. The charge is wrong because the specimen list was in free text. The denial cannot be appealed because nobody can find the requisition. The lien payoff is wrong because a corrected report changed the level after the statement went out.
Coding from structure, not from keywords
- Surgical pathology level proposed from the specimen list and the final diagnosis, with the reasoning visible and a coder's override recorded rather than overwritten.
- Technical and professional component splits determined by place of service and billing entity, which is a configuration fact and not a judgment call.
- Add-on codes enforced against their parent, so an orphaned add-on never reaches a clearinghouse.
- Mutually exclusive pairs blocked at entry with the rule cited.
- Level distribution monitored against the laboratory's own case mix, because the audit that eventually arrives will be about distribution.
Coverage evaluated before submission
Coverage determinations are evaluated at accession and again at sign-out. A screening procedure that becomes diagnostic, a reflex that a policy does not recognize, a frequency limit already met this year: all of these are knowable before submission and expensive afterward. Where a determination is ambiguous, the case is flagged for a human rather than resolved by an optimistic default.
Denials become retrievals
| Artifact | Answers |
|---|---|
| Requisition | Who ordered it, with what stated indication |
| Result version at submission | What was true when the claim went out |
| Coverage evaluation | Which policy was applied and what it concluded |
| Coding decision and overrides | Why this level, and who decided |
| Interface message | That the result exists and when it arrived |
| Disclosure record | What was sent to the payer and when |
Lien accounting
Lien-based receivables age differently from insurance receivables and behave differently on a balance sheet. Position, payoff, reduction history, and attorney of record are tracked as first-class objects. A corrected report that changes a charge propagates to the payoff figure rather than leaving a stale number in a letter.
Where this sits in the portfolio
Metaclinic is the billing and MSO infrastructure inside Deploy Holdings, alongside a pathology laboratory information system and a remote monitoring platform. The diagnostic data layer described across this site is the shared foundation those products stand on.
Letters of medical necessity
Where coverage turns on an argument rather than a code, the argument is assembled from the record against the criteria of the policy actually in force, with every assertion cited to its source and unmet criteria reported as unmet. The treating clinician signs it or it does not go. How that works, including what it deliberately will not do.
Attestation is the precondition, not a feature of it
Everything above assumes the charge is defensible in the first place. A charge is refused until the service exists as a recorded event, the record it rests on is attached, and the rendering clinician has signed for it against that specific version — with every step written to a log that cannot be revised. That is documented on its own page, because in a lien book it is the argument that actually gets had.
What a first conversation covers
Current receivable and its age, payer mix, what the incumbent system can export, and whether the book is insurance, lien, or both. That is enough to give a straight answer about fit rather than a proposal.
Which stakeholder is currently asking you for data you cannot easily give them?
That is the useful first conversation, and it is a short one. Bring the laboratories, the practices, and the thing that breaks today.
service@meta.clinic Read the release model first