Inappropriate genetic test claims are often mistakenly paid because claims systems can’t identify the actual test(s) performed and apply correct policy. In fact, research shows that 30 percent of genetic testing claims are coded inaccurately. Other factors that contribute to higher-than-necessary costs for genetic testing include lack of medical necessity, volume billing, and widely variant allowed amounts for the same test.

In this webinar, originally presented with AHIP, we address:

  • The impact of genetic testing cost trends on your plan’s genetic testing spend, at a time of drastically increased testing costs due to COVID-19
  • Practical strategies for reducing unnecessary genetic test claims payments, such as incorporating automated claims edits and payment rules into your pre-pay environment and post-pay recoupment strategies
  • How the results of genetic claims analysis can inform lab contract negotiations
  • How our approach saved $0.25 PMPM in its first year

Learn more about our Payment Integrity solution for health plans as part of our full-cycle Genetic Benefits ManagementTM services. Or, if you’re ready to chat or to schedule a complimentary savings analysis for your plan, email us at; or, call us at 844-846-3763.


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