NewBecker's 2026 Top RCM · Inc. 5000 · Dallas 100
A behavioral health platform grew collections by $2.4M / year with Plutus Health →
SOC 2 Type 2 · HIPAA · BHCOE · CASP
Plutus Health combines specialty lab billing experts with OlympusAI to keep high-volume lab claims accurate, compliant, and moving.
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Clinical Laboratory Fee Schedule updates under PAMA affect covered test reimbursement every year. Outdated billing rates create avoidable revenue loss across high-volume procedures.
BRCA panels, hereditary cancer testing, pharmacogenomics, and molecular diagnostics require test-specific clinical justification before submission.
Proprietary Laboratory Analyses codes must match the manufacturer, test name, NPI, and payer requirements. Incorrect attribution triggers denials.
Our team understands clinical chemistry, pathology, toxicology, molecular diagnostics, genetic testing, and payer-specific lab billing rules.
Eligibility, benefits verification, prior authorization, medical necessity, and patient demographics are validated before claims are created.
Specialty lab AR requires fast denial action, payment variance tracking, payer follow-up, and underpayment recovery at scale.
OlympusAI supports specialty lab billing workflows by validating payer rules, test requirements, documentation, and reimbursement patterns before claims move downstream
Accurate demographics, eligibility, ordering provider details, diagnosis linkage, and payer routing prevent avoidable rejections.
Each test requires the correct CPT, HCPCS, and PLA codes, modifiers, medical-necessity support, and payer-rule validation.
Paid amounts are compared against expected reimbursement, so underpayments and payer variances are identified early.
Eligibility, benefits, prior authorization, medical necessity, and payer requirements are checked before services are billed.
Claims are reviewed for test codes, diagnosis linkage, payer edits, demographic accuracy, and documentation completeness.
Denials, aged AR, underpayments, and payer issues are routed to senior specialty lab billing experts for resolution.
We are delighted with the tech-enabled RCM solutions we received from the Plutus Health team. They are always keen to provide the best possible solutions to all our problems. Partnering with Plutus Health helped streamline our specialty lab billing and coding services.
We diagnose your current state, baseline the leakage, and show you the to-be model.
The diagnostic is free. The findings are yours to keep, regardless of whether we work together.
Board-ready findings memo, quantified leakage estimate, transformation roadmap.
