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Laboratory Affordability Products

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

The impacts of genomics and affordability

While lab-developed tests offer 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. It can be a specialized and costly process. 

Integrate our cutting-edge science to better manage your genomic and routine laboratory reimbursement.

Accurate payments and testing management

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

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

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

Key benefits

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.

Manage laboratory spend and utilization

  • Limited federal oversight, until recently, with no single identifier or framework for evaluating test quality
  • 175K+ clinical genetic tests1
  • 500+ CPT® codes available2
  • Need for greater transparency and alignment
  • $2B+ of fraud identified by U.S. Department of Justice annually for code stacking3

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Learn how we can help make your laboratory spend more affordable

Complementary solutions

DME Navigator

Our integrated durable medical equipment (DME) solution helps health plans manage spend while improving the experience for members, DME suppliers and the ordering providers

Ancillary benefits management

Reduce the burden of managing ancillary benefits programs separately across the care continuum. Our solutions leverage an affordability framework to close gaps for better care with lower costs.
  1. Halbisen AL, Lu CY. Trends in Availability of Genetic Tests in the United States, 2012-2022. J Pers Med. April 6, 2023; 13(4):638.
  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.