Payer Policy Conflicts & Guidelines: Harmonizing LCDs, MolDx, and Commercial Plans

As payer policies become more complex, they're also becoming increasingly misaligned. From Local/National Coverage Determinations and MolDx technical assessments to evolving commercial payer guidelines, laboratories are navigating a reimbursement environment where conflicting requirements and policy gaps can directly impact cash flow.

In this webinar, Lighthouse's Ann Lambrix will join Tara Cepull of Quadax to break down how these policies function, where disconnects commonly occur, and what labs must do to proactively meet medical necessity and coverage criteria in order to protect their revenue.

During this webinar, attendees will learn to:

-Understand the intent and mechanics behind LCDs, MolDx, and commercial coverage policies
-Identify when Z-Codes, technical assessments, or additional registration steps are required
-Navigate conflicting payer policies and respond strategically to denials
-Strengthen documentation to support medical necessity and audit defensibility
-Leverage AI tools to extract clinical data and validate claims against coverage criteria

If your lab is facing increased payer scrutiny or reimbursement uncertainty, this session will provide practical guidance to help you harmonize policy requirements and get paid with confidence.