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Laboratory affordability products

Reduce your lab spend and improve patient outcomes with a comprehensive approach.

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The impacts of genomics and affordability

Integrating this cutting-edge science into routine health care requires addressing obstacles as it remains specialized and costly. While lab-developed tests provide valuable insights, ensuring test quality remains crucial for reliable results and comprehensive health plan coverage is paramount.

Evolving state-level biomarker mandates encourage insurers to cover comprehensive testing, but policy gaps persist, and patients may face cost hurdles. We offer solutions for every step of your cost-of-care journey that manage genomic and routine laboratory reimbursement and utilization.

Our comprehensive approach optimizes quality while reducing spend

Test identification and quality

We have an exclusive partnership with Palmetto GBA, the administrator of DEX® Z-Codes and the DEX test registry.

Network solutions

Realize cost savings with pricing solutions at the individual test level.

Decision support

Medical and reimbursement criteria for a broad range of laboratory testing to help drive automation and clarity.

Claims management

Our solutions contain automated enforcement of policies leveraging DEX Z-codes and proprietary authorization to claim matching rules.

Genomics payment manager

Optum Genomics Payment Manager, available exclusively through a license with Palmetto GBA and the DEX Diagnostics Exchange Registry, facilitates alignment among health plans, providers and labs. It ensures accurate claim submission and reimbursement by providing essential information for genetic testing claims.

This innovative solution addresses the challenges posed by rapid growth in this field, surpassing traditional policy and coding structures.

Laboratory benefits management

Optum collaborates with Avalon Healthcare Solutions to provide comprehensive laboratory benefits management.

Routine Testing Management focuses on controlling utilization through policy management and automated adherence. Up to 30% of lab tests may be unnecessary, and there’s a 2x-3x cost variation across different sites.

Precision Genetic Testing Management focuses on genetic test utilization through policies, prior authorization services, and unique genetic test identification.

See how we can help make laboratory spend more affordable

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  2. Laboratory Hub. Understanding CPT and ICD Codes in Laboratory Billing. Accessed June 28, 2024.
  3. U.S. Department of Health and Human Services Office of Inspector General. Nationwide Genetic Testing Fraud. Accessed June 28, 2024.
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  5. Shrank WH, Rogstad TL, Parekh N. Waste in the US Health Care System: Estimated Costs and Potential for Savings. JAMA. Oct 15, 2019;322(15):1501-1509.