Genetic Testing Solution
Harness the health revolution
Our Genetic Testing Solution helps reduce your health plan’s spending on unnecessary — and potentially harmful — genetic testing and helps deliver clarity to your members. We do this by promoting evidence-based clinical criteria that emphasizes appropriate testing at in-network labs. We also connect board-certified genetics professionals to your providers, helping them choose the right tests, and to your members for genetic counseling, helping them understand test results.
Lines of business
• Commercial
• Medicare
• Medicaid
• Federal employee
What if clinical integrity was embedded within genetic testing?
When used appropriately, genetic testing can help your providers and members make complex care decisions. But, as more specialties rely on it and the number of available tests grows each year, providers are especially challenged to keep up with the latest evidence. Our solution guides them to the right tests based on your members’ specific needs.
Keep your members’ care on track
Enthusiasm for genetic testing can quickly drive unnecessary testing and anxiety for your members. We help prevent that. With our solution, your members avoid testing that is unnecessary and/or performed at out-of-network labs.
Scale the right decisions across your network
Few specialties involve as much complex decision-making as genetic testing. We bring greater clarity to it. When we partner with your health plan, your providers gain direct access to genetic experts to help them select the right test.
Harness your spending with our rigorous evidence
In genetic testing, high spending can result from low-value tests, overutilization, and expensive labs. We optimize for them all, for you. Our proprietary genetic testing medical policies help curb expenses associated with unnecessary genetic tests.
Inside our Genetic Testing Solution
Managing genetic testing presents dynamic challenges. We’ve reimagined how to use clinical expertise and progressive technology to address all those challenges and more, at scale. Our solution automates guidance on test selection and redirects testing to your in-network and preferred labs. Our team of board-certified genetics professionals are available to provide consultation to your providers and members.
Clinical appropriateness review
Practice engagement resources
Telephonic genetic counseling (optional)
Laboratory network consultation
Advanced analytics and reporting
How our solution works
Request
Your providers submit requests to us online or over the phone.
Review
Our automated platform reviews the requests in real time.
Determine
Requests that meet clinical criteria are immediately approved. Clinical reviewers, including genetics experts and physicians, are available to consult with your providers about any requests that don’t meet our clinical guidelines and/or health plan medical policy. You also can opt to make genetic counseling available to your members when clinically indicated.
Synchronize
Request data is shared with your system(s) for claims, care management, and/or reporting purposes.
Explore related solutions
Ask us about our Genetic Testing Solution
Health plan leaders, contact us to learn more about the possibilities and impact of our Genetic Testing Solution.
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 health plan ID card.
Provider inquiries
For questions about a request or the Provider Portal: Call 1-800-252-2021 or contact our support team
Business hours: 8:00 a.m. – 5:00 p.m. CST.
