Billing, insurance, and reference labs for public health

Salus is purpose-built for public health laboratories and the reference laboratories that serve public-health networks. Commercial outpatient clinical labs and full commercial revenue-cycle management are out of scope. That clarity keeps the product honest: ELR, surveillance, federation, and human-governed AI stay first-class, while finance supports how PHLs and reference labs actually get paid.

Reference laboratories inside a state or multi-jurisdiction network need the same accessioning-to-result spine as a county PHL, plus clear routing for send-outs and sealed custody when specimens move between organizations. Salus treats reference as a first-class lab kind, not an afterthought bolt-on.

At intake, a specimen can carry an insurance payer, a purchase-order number, and a member id when the program requires it. Fee schedules support list prices, submitter overrides, and insurance-scoped rates so Medicaid or program pricing wins when the specimen is covered that way.

Charges roll into invoices by submitter and billing cycle. From an issued invoice, the lab can generate a representative X12 837 professional or institutional claim bound to a directory payer. Emma, the CFO persona, scans unbilled aging, draft invoices, AR aging, rejected claims, fee gaps, and missing insurance or PO context - and never issues an invoice or submits a claim alone.

Eligibility checks, ERA/835 remittance application, denial-code workflows, and payer-certified 837 mapping are not claimed as complete. PHLs that need full commercial RCM should expect either integration to a clearinghouse or ERP, or a later wave of Salus finance depth. The ledger and Emma are the foundation, not a false claim of certified payer enrollment.

For procurement and WHO-style stakeholder questions: technologists, directors, QA, epidemiology, bureau leadership, finance (Emma + human CFO), and security (Eva) each have a product surface. Gaps are documented rather than papered over.