Benefit Management
Precision Genetic Test Management
Unlock clarity, control, and cost-efficiency in genetic testing with Avalon’s next-generation management solution—powered by our proprietary Diagnostic Insights Platform.
Genetic testing continues to grow, but the market lacks alignment.
Genetic testing is evolving rapidly, with over 175,000 tests available and 10 new ones introduced daily. Yet the market lacks alignment in coding, clinical evidence, and reimbursement, leading to:
- Gaps in provider knowledge and test interpretation
- Inconsistent coverage and authorization practices
- High variability in test quality, cost, and utility
- Lack of coding specificity
Managing this complexity requires more than coding logic—it demands diagnostic intelligence.
Powering smarter genetic testing with diagnostic intelligence
Precision Genetic Test Management (PGTM) is the advanced evolution of genetic testing management—combining Avalon’s lab science expertise and powerful claims intelligence with leading payment accuracy capabilities. As part of our Diagnostic Intelligence platform, PGTM transforms fragmented genetic workflows into a strategic, scalable solution that ensures the right test is performed at the right time.
How Precision Genetic Test Management Works
Avalon’s PGTM model combines five key capabilities to deliver actionable value:
01
Policy Development
Proprietary, evidence-based policies developed by in-house scientists and validated by an independent Clinical Advisory Board.
02
Test Identification & Quality
DEX Z-Code®-driven classification of genetic tests to ensure appropriateness, specificity, and clinical validity.
03
Utilization Management
NCQA-accredited prior authorization processes and automated provider decisioning and clinical reviews based on health plan policies.
04
Payment Accuracy
Automated claim coding rules to enforce lab policies and validate authorization decisions during post-service claim adjudication.
Value for Health Plans
Avalon’s PGTM solution simplifies complexity, reduces costs, and improves member care through diagnostic management precision:
- Increased outpatient genetic lab savings of $0.50–$0.65 PMPM
- Reduces fraud, waste, and abuse (FWA)
- Minimizes abrasion for providers and labs
- Reduces Prior Authorization burden
- Improves care quality through better test alignment
Integrated with Diagnostic Intelligence
PGTM is a core pillar of Avalon’s Diagnostic Insights Platform—a comprehensive system integrating lab network design, utilization enforcement, routine and genetic testing, and claims intelligence.
By embedding PGTM into a broader diagnostic strategy, health plans gain a scalable, modular solution that continuously delivers value, from point-of-care decisions to enterprise-level performance.
Ready to simplify genetic testing?
PGTM delivers clarity where it’s most needed—in the complexity of precision diagnostics. Contact Avalon to learn how we’re helping health plans control spend, improve outcomes, and navigate the future of genetic testing with confidence.