100%
of CMS for commercial claims
90%
of CMS for Medicare
How PayrHealth Helped PathNet Break Through Payor Barriers in a Closed Market
About PathNet
PathNet is a specialized fully digital pathology laboratory that allows pathologists to provide diagnostic readings remotely. Their operations are anchored by technical operations in Arkansas, while their team of pathologists reviews lab samples referred from a variety of clinical groups nationwide.
Client Need
As a tech-forward, non-traditional lab, PathNet needed a strategic partner to help them secure payor contracts and navigate complex credentialing processes in an increasingly closed and competitive market. Despite their innovative model and growing referral base, PathNet faced significant hurdles in securing in-network status with a large, national payor—particularly in Utah, where the payor’s lab network had been closed nationwide for over a year.
Historically, labs and DME providers have faced closures due to payors deeming their networks adequate, leading to blanket denials for new entrants. For PathNet—whose business depends entirely on lab services—being excluded from major payor networks was a direct threat to growth and revenue.
Even in Arkansas, the road to in-network status required strategic coordination, extensive credentialing, and relentless follow-up.
PayrHealth’s Solution
PayrHealth began working with PathNet three years ago and in that time has:
- Developed and told PathNet’s story to key payor contacts to demonstrate their value
- Navigated and overturned multiple initial denials from major payors
- Credentialed individual providers and rolled them into group contracts
When a large, national payor in Utah initially denied PathNet’s application, PayrHealth didn’t take “no” as a final answer. Instead, the team launched a months-long appeal process, leveraging deep market relationships, local contacts, and a persistent strategy of storytelling and follow-up to change the outcome.
Client Outcomes
PayrHealth successfully overturned that initial denial—a major win considering the lab network in Utah remained closed to most applicants.
Not only that, PathNet received the same elevated reimbursement rates including:
- 100% of CMS for commercial claims
- 90% of CMS for Medicare
These rates far surpassed the industry norm for labs (typically ~60% of CMS) and directly reflected PayrHealth’s ability to demonstrate PathNet’s differentiated model and value to the network.
Additionally, PayrHealth Secured nearly 50 contracts and handled complex credentialing work across both markets, including manually linking individual providers to ensure PathNet’s group contract could be established and recognized by a large, national payor.
“PayrHealth was instrumental in helping us get off the ground during a critical growth phase. Their team's persistence in navigating credentialing and overturning closed-network denials gave us access to markets that would have otherwise remained out of reach. We appreciated their deep understanding of the lab space and the hands-on support they provided throughout our time working together."
Contact PayrHealth
Having negotiated over 50,000 contracts in all 50 states, PayrHealth has the knowledge and expertise to secure highly competitive rates and terms for your contracts, no matter how outdated they are or how big a player the payor is. We also have a team with over 40 years of experience in management of revenue cycles and helping you close down on lost revenue through your practice. Contact us today to learn more.
