Magellan Healthcare, Concert Genetics to Improve Genetic Testing

Magellan Healthcare and Concert Genetics recently collaborated to offer an innovative, end-to-end solution that delivers efficient management, improved quality, and accurate payment in genetic testing.

The genetic landscape has changed and evolved throughout recent years, with over 175,000 orderable tests on the market today and an expected annual growth rate of 13%. But experts note that coding in a rapidly evolving field can lead to challenges in managing administrative processes.

And the effort required to manage genetic testing can seem endless due to the volume of tests available, a Magellan Health spokesperson said. Current medical policies for genetic tests can be difficult to navigate and often fall behind the continuously evolving landscape of new tests, evidence, and guidelines.

Therefore, the companies will leverage Magellan’s utilization management processes and claims integration to combine an authoritative catalog of genetic tests and unique ID systems with regularly updated medical policies, test-specific cording standards, lab-quality information, and real-time claim editing capabilities.

“Magellan Healthcare’s new genetic testing solution will enable health plans to manage variation and risk while reducing administrative burden and medical costs,” Sajel Lala Kana, MD, FACMG, board-certified geneticist and physician clinical reviewer for Magellan Healthcare, said in the announcement.

“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,” Kana continued.

The solution's key features include expert-informed medical policies and guidelines, including machine-readable medical policies mapped to categories and domains of testing that allow providers and health plan reviewers to quickly identify relevant policies for each test.

Additionally, the solution offers pre-payment, post-service claim edits, prior authorization, and a proprietary technology platform. The platform links all genetic and molecular tests with policies, codes, and prices.