Management across the universe of genetic testing
Genetic testing is dynamic, fast-growing and highly complex. Unreliable coding, variable pricing, limited quality assessments and an ever-changing landscape of laboratories and tests result in disproportionate time and effort being spent on management. Errors and overpayments occur frequently, and waste is common. Magellan Healthcare’s comprehensive solution, powered by Concert Genetics, delivers value through pre-payment, post-service claim edits for all genetic tests and prior authorization for tests that are high-cost and have a high potential for misuse.
- Expert-informed medical policies and guidelines—Machine-readable medical policies mapped to categories and domains of testing allow providers and health plan reviewers to easily identify relevant polices for each test.
- Pre-payment, post-service claim edits—Payment integrity and clinical claim edits provide plans with fundamental controls for improving oversight of genetic and molecular testing laboratories and are applied to low-cost, high-volume tests.
- Prior authorization—Medical necessity reviews conducted by Magellan specialty-trained staff for tests that are high-cost and have a high potential for misuse maximize program value.
- Proprietary technology platform—Claim edits and other automation are enabled through a unique, comprehensive platform that links all genetic and molecular tests with policies, codes and prices.
Webinar – Genetic Testing: Effective Management Strategies
In this webinar, Magellan’s Caroline Carney, MD, MSc, FAPM, CPHQ, chief medical officer, and Concert Genetics’ Rob Metcalf, chief executive officer, and Gillian Hooker, PhD, ScM, LCGC, chief scientific officer, discuss problems with this expanding market, management strategies designed to address this complex area of healthcare and Magellan’s genetic testing solution, and answer audience questions. Watch the recording here.