Genetic Test & Utilization Management Oversight
How Avalon brings clarity, compliance, and cost control to one of the fastest-growing areas in diagnostics.
Avalon’s Approach
Avalon simplifies the complexity of genetic testing with oversight that aligns tests to plan policies and ensures appropriate utilization.
- Applies DEX Z-Codes® to align tests with payer requirements
- Automates prior authorization to streamline workflows and reduce administrative burden
- Ensures appropriate lab usage through policy-driven oversight
- Transforms genetic workflows into scalable, strategic solutions powered by Avalon’s Diagnostics Insights Platform
This approach reduces risk, improves decision-making, and delivers cost-effective management for high-volume, rapidly evolving test categories.
Proven Impact
Avalon’s Precision Genetic Test Management solution helps provide test specificity to more than 40K genetic tests assigned to CPT code 81479. In addition, national and regional health plans have increased outpatient genetic lab savings by $0.50–$0.65 PMPM.
Key Capabilities Used
- Genetic Test Management Program & Evidence-based Genetic Policies
- Test Identification & Quality leveraging DEX Z-Code® Matching
- NCQA-accredited Utilization Management
- Payment Accuracy in Collaboration with Optum
- Avalon’s Diagnostics Insights Platform
Impact
- Increased genetic lab savings
- Reduces fraud, waste, and abuse (FWA)
- Minimizes abrasion for providers and labs
- Improves care quality through better test alignment
- Reduces Prior Authorization burden