Genetic Test Payment Integrity for Health Plans

View this three minute video below on how our Payment Integrity Solution could help your plan reduce genetic test payments by 18-45%.


Many health plans are addressing the rapid growth in genetic testing with utilization management (UM) programs, such as prior authorization. However, a substantial opportunity to further reduce inappropriate genetic test spend is often overlooked — overbilling, and subsequent overpayment, for genetic tests.

Based on our actual client work — as well as the expertise of the nation’s largest independent organization of genetics specialists — we’ve developed rule sets that enable health plans to identify specific tests and panels in the claims adjudication process and apply coverage policy to reduce overpayments.

Download your copy of our guide, “Eliminating the Hidden Costs of Genetic Testing Claims” – just submit the short form below.

This guide and associated webinar explore ways that payers can better identify and reduce inappropriate 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

Click here to watch a replay of the webinar hosted with AHIP.