Case Study:
Nationwide Medicaid & Commercial Enrollment for a Clinical Lab
“A specialized clinical laboratory approached us with the goal of getting enrolled in all U.S. Medicaid programs as well as securing contracts with major commercial payers. While they operated in a highly saturated market, the lab had developed a proprietary testing method that offered greater accuracy and faster turnaround times—making them uniquely positioned to serve both patients and payers.”
The Challenges
Despite its innovation, the lab faced several enrollment hurdles:
- Market saturation made payers hesitant to contract with new labs
- Medicaid programs and commercial plans typically prioritize existing, in-network labs
- The lab needed to communicate why its testing method was distinct and valuable
- Commercial payers required justification for higher reimbursement rates
Our Solution
Umulisa Health designed and executed a strategic enrollment plan that highlighted the lab’s innovation and value:
Developed custom Letters of Intent (LOIs) for each payer and Medicaid program, clearly explaining:
- The lab’s proprietary testing method.
- The clinical benefits to members (e.g., improved outcomes, faster diagnostics).
- The cost-efficiency and preventive value for payers.
- Positioned the lab as a differentiated solution in a crowded market.
- Managed the credentialing and enrollment process for all 50 states’ Medicaid programs.
- Negotiated favorable commercial contracts by providing data and clinical justification for premium reimbursement rates.
The Results
Successfully enrolled the lab in all U.S. Medicaid programs
Secured high-paying commercial insurance contracts across multiple states
Positioned the lab as an innovator in diagnostic testing, opening new markets
Enabled the lab to expand nationwide with payer recognition of its proprietary value