Tuesday, April 26, 2022
Magellan Healthcare, the behavioral health and specialty division of Magellan Health, Inc., today announced a new collaboration with Concert Genetics, a software and managed services company that provides the data and digital infrastructure to manage genetic testing. Working together, the two companies will offer an innovative, end-to-end solution that leverages Magellan’s utilization management processes and claims integrations to deliver efficient management, improved quality, and accurate payment in genetic testing.
The genetic testing landscape has changed dramatically and continues to evolve. With more than 175,000 orderable tests on the market1 and an estimated annual growth rate of 13%,2 the rapid expansion of genetic testing, combined with its complexity, is challenging stakeholders across the healthcare system. Variation in coding and billing generates ambiguity and can lead to unnecessary review costs. Thousands of code variations exist, and on average, 6.9 codes are billed per test.3 Complex coding in a rapidly evolving field can lead to challenges with managing administrative processes, such as claims editing.
Due to the volume of tests available, the effort required to manage genetic testing can seem endless. Despite accounting for 1%-2% of medical spend, health plans can dedicate as much as 15% of clinical reviews and 20% of medical policies to this area. Additionally, current medical policies for genetic tests can be difficult to navigate, leading to inconsistent application and errors, and often fall behind the continuously evolving landscape of new tests, evidence, and guidelines.
The new solution will combine an authoritative catalog of genetic tests and unique test ID system with regularly updated medical policies, test-specific coding standards, lab quality information, and real-time claim editing capabilities, all delivered through Magellan’s proven delegated delivery model.
“Magellan Healthcare’s new genetic testing solution will enable health plans to manage variation and risk while reducing administrative burden and medical costs,” said Sajel Lala Kana, M.D., FACMG, board-certified geneticist and physician clinical reviewer for Magellan Healthcare. “Removing the ambiguities surrounding genetic tests, codes, and medical policies opens the door to a new, innovative approach that supports payers in this complex space.”