Lab Insights Solutions

Precision Genetic Test Management

Next-generation solution to manage growth and costs of genetic testing.
Challenges

Genetic testing is exploding, and management is complex.

There are roughly 175,000 genetic tests available with 10 new tests hitting the market each day. There are only ~500 CPT codes available to identify all of those tests. This results in gaps in provider awareness and expertise; variations in coding, coverage, and reimbursement practices; a lack of rigorous clinical evidence and regulation; and wide variability in the quality and utility of precision tests along with the lack of genetic test specificity.

Our Solution

Innovative Genetic Test Management Necessary to Address Complexity

Precision Genetic Testing Management (PGTM) is the next evolution of Avalon’s genetic test management solution combining the lab testing expertise of Avalon with accurate claims data to produce a first-of-its-kind solution to manage genetic testing.

PGTM leverages the use of industry-standard DEX Z-Codes® mapped to evidence-based lab policies, enabling discrete test identification, test quality and validity. This supports automated prior authorization approvals. The result: improved and streamlined care with plan savings.

Avalon’s Lab Insights Solutions work together to arm you with critical lab-driven insights to accelerate your value-driven care success. ​
circle_grid Routine Test Management Lab Values Management Curated Lab Network Precision Genetic Test Management

PGTM aligns Z-Codes® scientifically-backed policies,
and technology bringing clarity in decision-making and an improved genetic lab benefit experience for all stakeholders. Avalon estimates savings of $0.50 to $0.65 per member per month with our
PGTM solution.

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Health Plan Value

Manage genetic testing spend across lines of business with minimal abrasion using evidence-based guidelines.

  • Minimize abrasion of plans, providers, and members by automating, or for select procedures removing requirement for, prior authorization through the use of Z-Codes and evidence-based lab policies.
  • Reduce fraud, waste, and abuse, which reduces expenditures.
  • Increase savings and reduce administrative burden.
  • Improve care quality- ensuring the right test.
Lab Value

Simplify the process and expedite reimbursement.

  • Simplify processes and reduce administrative burden for providers.
  • Expedite prior authorization and reimbursement.
  • Steer patients to higher-quality lab providers.
  • Consistent price across national network.

Learn how we’re helping health plans navigate the complexity of genetic testing.

Managing Genetic Tests: Navigating Compliance and Avoiding Potholes

Tuesday, March 19
2 – 3 p.m. EST

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