In the genetic testing space, cost management is particularly challenging because of new genetic technology that enables rapid development of new tests. There are currently nearly 175,000 genetic tests on the market, with an additional 10 entering each day.
This trend places a growing burden on genetic clinicians to keep pace with the accuracy and utility of the latest genetic research, while health plans are faced with determining medical necessity, coverage guidelines and complicated billing.
Because of the severe imbalance that exists between the number of available Current Procedural Terminology (CPT) codes and the number of genetic tests (400 CPT codes, 175,000 tests), it is estimated that 30% of all genetic tests are coded incorrectly – a real challenge to healthcare cost management. The coding gap results in many health plans overpaying to the tune of millions of dollars annually.
The solution? Utilizing the experience and expertise of InformedDNA.
InformedDNA has vast experience in the genetic services space, with the largest in-house staff of certified specialists in the country. We deliver the real-time insights and solutions our clients need to optimize clinical decisions, improve outcomes, and realize cost savings and benefits at scale.
Our Genetic Testing Utilization Management solution offers:
- Up-to-date evidence-based coverage guidelines across all genetic testing specialties; CPT insights are released quarterly as new codes are introduced
- In-house genetic counselors who can help your health plan avoid internal strain and administrative burden
- Accurate and efficient case approvals with smart automation; our Genetic Testing Utilization Management solution has a multi-step review process that checks each request against the most current, evidence-based genetic testing guidelines and clinical utility criteria
- Easy access to broad clinical genetics expertise using the most current resources to inform coverage policies and decisions, resulting in fewer appeals
- 100% concordance on interrater reliability tests for complex categories of prior authorization reviews; you can rely on our team of experts to give you the best decision, every time
We are committed to:
- Reducing overuse of unnecessary testing
- Reducing complexity of medical policy management
- Generating cost savings
- Promoting standards of care
Whatever combination of cost management solutions is selected, the expert team at InformedDNA provides ongoing quality control measures to ensure our claims editing is accurate and working appropriately. InformedDNA enables health plans to stay ahead of the curve by augmenting a plan’s in-house team with our comprehensive clinical genetics expertise.
