Align routine and genetic lab testing with clinical guidelines
Today, 30% of all lab tests are unnecessary.* The absence of industry standards and clinical efficacy data can lead to unnecessary utilization and misinterpretation of tests. This can result in unsupported interventions and potential safety risks for members.
Lab Benefit Management from Optum and Avalon Healthcare Solutions aligns lab testing with clinical, evidence-based guidelines that better meet member needs and support cost savings for health plans.
Routine Test Management
Our industry-leading automated Routine Test Management solution supports adherence of lab testing to scientific and evidence-based criteria, evaluating laboratory claims to facilitate accurate reimbursement for clinically relevant tests.
This process occurs in near real time. Routine Test Management employs extensive rules to review lab test consistency with clinical conditions and alignment with health plan policies.
Precision Genetic Test Management
Precision Genetic Test Management brings together specific genetic test policies and prior authorization services with a unique genetic test identification and technical assessment process.
With a strong emphasis on test quality, the solution helps health plans make coverage determinations based on clinical evidence, physicians have transparency on test quality and patients receive the most appropriate genetic test.
Key benefits
Our comprehensive approach optimizes quality while managing spend.
Scalable innovation
We help validate that routine and genetic lab testing follows guidelines in a scalable way, with automated lab policy adherence technology and prior authorization services.
Payment accuracy
By translating evidence-based policies into coding and coverage rules, we help plans shift from routine lab cost-containment to affordability.
Unique genetic test identification
Through our exclusive partnership with Palmetto GBA, we provide unique genetic test identification with DEX® Diagnostic Exchange codes (DEX Z-Codes).
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Complementary solutions
DME Navigator
Ancillary Benefits Management
Sources
*Zhi M, Ding EL, Theisen-Toupal J, Whelan J, Arnaout R. The landscape of inappropriate laboratory testing: a 15-year meta-analysis. PLoS One. 2013 Nov 15;8(11):e78962. doi: 10.1371/journal.pone.0078962. MID: 24260139; PMCID: PMC3829815.