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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:

provider satisfaction rate driven by in-depth education and peer-to-peer consultations
0 %
authorizations of medically-necessary tests with genetic analyst support
0 X
requested test is modified/redirected to a more appropriate test or the request is withdrawn
0 %

Avoid Unnecessary Costs With Prepay
Prevention and Proficiency

Avoid unnecessary spending with 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 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 multi-step 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 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 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, results 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

Reduce complexity

of medical policy

Generate cost savings

through medical necessity review and lab/test redirection

Promote standards of care

by educating providers on evidence-based criteria


Prior to partnering with InformedDNA®, a single case could require up to 4 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

We’re dedicated to helping payors and partners better navigate this landscape, keeping costs in check and making the best use of resources.

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