Genetic Test Claims Guide for Health Plans

“Eliminating the Hidden Costs of Genetic Testing Claims”

Many health plans are addressing rapid genetic testing growth with utilization management (UM) programs, such as prior authorization. But, some key areas of inappropriate genetic testing cost are often overlooked: Overbilling and subsequent overpayment for genetic tests.

Based on our actual client work with many of the nation’s largest health plans — as well as the expertise of the nation’s largest independent organization of genetics specialists — we’ve identified a number of factors that contribute to higher-than-necessary costs for genetic testing.

This guide explores ways that payers can better identify and reduce unnecessary claims payments related to genetic testing by:

  • Building automated claims edits and payment rules into your claims processing system
  • Conducting analyses of genetic testing claims trends
  • Using the results of claims analyses to strengthen lab contract negotiations
  • Regularly monitoring genetic test claims to assess progress and pinpoint additional opportunities for improvement


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InformedDNA Genetic Testing Claims Guide