Genetics and Laboratory Solution
Optimize your genetic and lab testing management
Our Genetics and Laboratory Solution promotes evidence-based, clinically appropriate lab and genetic testing — which effectively manages costs for your health plan. We achieve this by delivering code transparency in ordering and billing practices as well as provider decision support around test selection and lab location.
Lines of business
• Commercial
• Medicare
• Medicaid
• Federal employee
What if clinical integrity was embedded within genetics and routine laboratory testing?
Lab testing influences up to 70% of medical expenses , making it one of the most significant points in a member’s care journey. A single lab test can determine the course of a member's care for days and months to come. Because of this, our solution is centered on evidence-based, decision-making support, to help ordering physicians make the most appropriate lab ordering decisions. Alongside more than 45 geneticists — one of the largest teams of board-certified genetic counselors in the U.S. — we offer unparalleled expertise for complex lab testing, too.
Flexibility that supports on-time care
Through pre-service clinical review for genetic testing and a post-service model for routine lab tests, we ensure that your members avoid delays for routine care. These processes are backed by extensive medical policies and clinical guidelines.
Guide physicians from the first step
Providers are empowered with the right guidance to make decisions about appropriate testing and lab network utilization. This drives better care for your members and helps lower costs.
Streamlined ordering process
Since our solution integrates with electronic health record (EHR) systems, your providers save time using an optimized process when ordering tests.
Inside our Genetics and Laboratory Solution
From routine panels to complex genetic testing, our solution supports appropriateness across the continuum of laboratory medicine to lower your overall lab costs.
Clinical appropriateness review
Physician decision-support
EHR integration
Proprietary code identification technology
Claims matching and editing
Laboratory network support
Advanced analytics and reporting
How our solution works
Request
Your providers submit genetic testing requests to us online or over the phone. Routine lab guidance is available through our integrated EHR and Lab Ordering Systems.
Review
Our automated platform provides real-time approvals when clinical criteria are met. For routine test requests, our editing technology performs instant and precise claim reviews.
Determine
Clinical reviewers, including board certified genetic counselors and physicians, are available to consult with your providers about any genetic test requests that don’t meet our clinical guidelines or your medical policies.
Synchronize
Request data is shared with your system(s) for claims, care management, or reporting purposes.
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Ask us about our Genetics and Laboratory Solution
Health plan leaders, contact us to learn more about the impact of our Genetics and Laboratory 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.
