Anthem Blue Cross has launched a genetic testing solution aimed at encouraging appropriate, safe, and affordable testing and counseling for patients.
The program is designed and administered by national specialty benefits management leader, AIM Specialty Health, which offers an automated system that guides the decision-making process.
Anthem’s Genetic Testing Solution promotes appropriate use and provides education that addresses the clinical and financial complexities of genetic testing. Through a combination of clinical review of testing requests and coordination with genetic testing laboratories, providers and members can draw upon verified resources to support clinical decision making.
Anthem’s program has been in place since July 1 and is being first used with its fully insured and self-insured members; national account members will be added in 2018.
“More than 70,000 genetic testing products are currently on the market, and an average of 10 new products are introduced every day,” says Razia Hashmi, MD, Anthem’s medical director for commercial business. “Stakeholders across the healthcare system are increasingly challenged to manage the pace of change.”
With a global market for such testing estimated at $10.3 billion market by 2024, the healthcare insurance and the industry in general is being thrust into an ongoing debate about how to handle the increasing array of complicated and costly tests.
Anthem believes the testing solution will improve the efficiency of the healthcare system for laboratories, doctors’ offices and insurers by moving from a manual, labor-intensive and post-service process to a real-time automated system that can deliver prior authorizations to doctors as they are sitting with their patients. The company also believes it will reduce the likelihood of errors in filling out paperwork, which adds to labor and time.
For many tests, using the solution can cut down the average time for submitting and processing an insurance claim from days to minutes because the prior authorization review provides specific CPT code information to the insurer to facilitate the claim processing, Anthem and AIM Specialty say.
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