Genetic Testing Solution
Genetic testing utilization management for better care decisions
Our Genetic Testing Solution helps health plans improve genetic benefits management by guiding appropriate test selection, applying evidence-based clinical criteria, and supporting the use of in-network labs. This approach reduces unnecessary genetic testing and connects care providers with genetics expertise.
Lines of business
- Commercial
- Medicare
- Medicaid
How genetic benefits management improves care and cost control
When used appropriately, genetic testing helps providers and members make complex care decisions. As more specialties rely on it and the number of available tests grows, keeping up with the latest evidence becomes more challenging. Our solution guides providers to the right tests based on your members’ specific needs.
Keep care on track
The growing use of genetic testing can quickly drive unnecessary testing and added concern for your members. Our solution helps prevent that by guiding appropriate use and supporting testing through in-network labs.
Scale consistent decisions
Genetic testing decisions are complex and fast-changing. We combine clinical guidance with access to genetics expertise to help providers make more consistent, evidence-based decisions across your member population.
Reduce unnecessary spend
Low-value testing, overutilization, and out-of-network labs can drive higher costs. We help health plans reduce unnecessary genetic testing and improve cost control through proprietary, evidence-based guidelines.
What’s included in our Genetic Testing Solution
Managing genetic testing presents dynamic challenges. Our solution brings together clinical expertise, technology, network support, and analytics to help health plans manage genetic testing from request through authorization and reporting. In addition, board-certified genetics professionals are available to consult with your providers when additional support is needed.
Clinical appropriateness review
Test selection guidance
Laboratory network consultation
Practice engagement resources
Claims to authorization matching
Advanced analytics and reporting
How genetic testing management and utilization review work
Request
Your providers submit requests to us online or by phone.
Review
Our automated platform reviews requests in real time against applicable clinical criteria.
Determine
Requests that meet clinical criteria can be approved immediately. When additional review is needed, our clinical reviewers, including genetics experts and physicians, are available to consult with your providers about requests that don’t meet our clinical criteria or the health plan’s medical policy.
Synchronize
We share request data with your system(s) for claims, care management, or reporting purposes, as applicable.
Ask us about our Genetic Testing Solution
Connect with us to explore the potential impact of our Genetic Testing Solution for your health plan.
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Frequently asked questions about genetic testing solutions
Are you a health plan member?
If you’re a health plan member and have a question about your health plan, please call the Member Services number on the back of your member ID card.
Provider inquiries: For questions about a request or the Provider Portal: Call 800-252-2021 or contact our support team .
Business hours: 8 a.m. to 5 p.m. CT.