Zelis Payment Integrity: Ahead of the Curve with Genetic Testing Edit Expansion

By Chris Stebbins, Senior Director, Product Development & Innovation 

The Zelis Claims Cost Solutions team has made an exciting leap forward with our latest Claims Editing platform expansion into genetic test editing. This expansion comes at a critical time, as the genetic testing market is rapidly growing and expected to become a $17.6 billion global market by 2025. This rapid growth presents many challenges to our clients including the variability of coding practices for multi-gene panel tests and code stacking to maximize the price of a claim. These issues can result in abusive overbilling that affect our payers and patients and require an expert solution.

“Editing for genetic testing ensures we will be prepared for the future progress of precision medicine. Our partnership positions us to proactively address the complexities and ambiguities in coding and billing errors, helping our clients manage higher costs,” said Dr. Priscilla Alfaro, Chief Medical Officer, Zelis

To address this problem comprehensively, we have paired our robust technology platform with our expert partner in the field of genetic testing, Concert Genetics. Together, we are able to not only deliver a best-in-class technology solution to address these claims, but also best-in-class clinical support from Concert’s team of genetic counselors. Our shared commitment to accurate and transparent billing will provide Zelis clients with the best possible solution to mitigate the growing costs associated with genetic testing claims.

Zelis continues to stay ahead of the curve in cost management strategies that bring together our clinical expertise, superior technology and the ongoing pursuit of a better healthcare ecosystem.