Genetic Testing Utilization Management
Customized solutions to meet your plan’s specific needs
Our Genetic Experts Have It Covered, so You Don’t Have to
Genetic testing utilization management has grown more complicated, fast. There are now more than 175,000 genetic tests on the market, with more than 10 new genomic tests and therapies being introduced daily.
Medical directors at U.S. health plans struggle to manage the growth and report these main challenges:
- Out-of-control costs
- Inadequate policy development
- Overwhelmed staff
- Growing provider abrasion
- Regulatory compliance
- Decision-making uncertainty
- Increasing complexity
If you can relate to any of these struggles, it’s time for InformedDNA’s Genetic Testing Utilization Management solution, customized to match the level of support you need. From a fully delegated solution to an online policy and decision support tool — and everything in-between — our genetics experts will help you determine the best solution and implementation plan.
Expert Prior Authorization Support Can Deliver:
Avoid Unnecessary Costs With Prepay
Prevention and Proficiency
Save money by utilizing current medical policy and coverage guidance
Rely on up-to-date, evidence-based coverage guidelines across all genetic testing specialties. CPT® Insights are released quarterly as new codes are introduced. You'll drive down costs by reducing the volume of clinically inappropriate tests and the associated downstream procedures.
Accelerate approvals with prior authorization automation
Ensure accurate and efficient case approvals with smart automation. Our Genetic Testing Utilization Management solution has a multistep review process that checks each request against the most current, evidence-based genetic testing guidelines and clinical utility criteria. This rigorous prior authorization process provides fast coverage decisions and quickly determines medical necessity, ensuring that when the right test is requested, it is approved for patients faster and with less administrative burden to payors.
Improve interrater reliability
Our genetics experts routinely achieve 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.
Decrease internal frustration and administrative burden
Overwhelmed clinical reviewers can't develop genetics expertise fast enough, and investing in that training is a high-cost proposition that takes years. Make us an extension of your team to reduce time and frustration spent in researching genetic conditions and tests and to make the right coverage determinations.
Avoid appeals and provider abrasion
Our Genetic Testing Utilization Management solution provides easy access to broad clinical genetics expertise using the most current resources to inform coverage policies and decisions, resulting in fewer appeals. Boost provider confidence with expert review and peer-to-peer consultation for complex cases and protect against appeals with supporting documentation and expert defense.
Controlled Costs and Improved Care
Reduce overuse
of unnecessary
testing
Reduce complexity
of medical policy
management
Generate cost savings
through medical necessity review and lab/test redirection
Promote standards of care
by educating providers on evidence-based criteria
Testimonials
Prior to partnering with InformedDNA®, a single case could require up to four hours of research. Now these are down to approximately 15 minutes and we are confident that these decisions are backed by genetics experts.”
Client contact
Utilization Management
Regional Health Plan
Without InformedDNA’s support, we would need to employ at least one full-time researcher in order to cover the depth of research needed to keep up with the rate of questions and new tests.”
Sue Vaughn, RN, Manager,
Utilization Management at
Physicians Health Plan
This was probably the most pleasant insurance-related, peer- to-peer conversation I have ever participated in.”
Ordering provider feedback
Let Us Prove It
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