Coverage Management

Reducing Inappropriate Use of Genetic Tests

The Challenges

  • Most claims are billed using non-specific CPT codes
  • Administrative costs of claims review processes
  • 20%-40% genetic tests are ordered inappropriately
  • High rate of use of non-network labs
  • Lack of insight into clinical use of genetic tests

Key Features

  • Web-enabled, automated preauthorization for molecular diagnostics
  • Eligibility verification
  • Clinical content and real-time coverage determinations for providers
  • Claim/preauthorization matching and validation 
  • Comprehensive reporting package 
  • Access to DNA Direct genetic experts to provide education and clinical support to physicians
  • Ability to integrate into existing health plan provider resources and/or lab ordering systems
  • Comprehensive URAC accreditation for utilization management

Value

  • Reduces inappropriate use of testing 
  • Enables insight into test utilization data 
  • Increases compliance with network labs 
  • Adds scale and reduces administrative costs
  • Creates platform for increasing clinical value from genetic tests

To learn more, contact DNA Direct.