Bend the test trend curve.
In conjunction with our partner, AIM Specialty Health®, we provide a fully automated genetic test prior authorization service, including a provider portal that enables instant approvals for 80-90% of approvable requests. When manual review is necessary, our genetic analysts consider case-specific information and evidence-based criteria in recommending an outcome. We also guide providers to alternative tests and labs when indicated by medical evidence - automatically.
Empower members to make informed medical decisions.
We employ a full-time staff of 60+ genetic counselors nationwide, to provide guidance directly to your members and providers, as warranted by your medical policy.
Co-Founder and Chief Medical Officer Rebecca Sutphen is one of the few physicians board-certified in clinical genetics, molecular genetics, and cytogenetics.
Get the most value out of your lab network.Our experience with millions of genetic test claims enables us to determine which labs offer the best value and reasonable billing practices. Our deep genetic test expertise enables us to understand which labs are most clinically appropriate to perform certain tests. We guide you on which labs are best to perform which tests for your members.
Consulting and Analysis
Drive additional savings and the most appropriate care.Our genetic specialists can provide ad hoc or ongoing consulting support to assist with coverage policy, payment policy and lab network development. We also provide detailed analyses of genetic test utilization patterns and savings opportunities.
Eliminate genetic test claim overpayments.About half of all unnecessary genetic test spend is from claims overbilling and overpayment. This is exacerbated by insufficient codes for test identification and the rise of gene panel billing. We provide claims edit algorithms that identify the specific tests performed, then apply evidence-based rules to block approval and payment of unnecessary claim line items or units.